FRI0025 DOES COMORBIDITY IMPACT ON THE ACTIVITY AND MANAGEMENT OF RHEUMATOID ARTHRITIS?
Authors: Aida Babaeva, Elena Kalinina, Maxim Zvonorenko, Karina Solodenkova
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Patients with rheumatoid arthritis (RA) are in increased risk of developing comorbid conditions. Recent data suggest the relationship between severity of RA and concomitant diseases [1, 2]. Drug therapy is considered as impotent risk factor for numerous comorbidities. On the other hand comorbidity can impact negatively on the RA course and on the pts management [3]. <h3>Objectives:</h3> The aim of our study was to evaluate the prevalence of concomitant conditions in RA pts, to compare the RA activity and management in relation with comorbidities. <h3>Methods:</h3> 168 pts with established and longstanding RA were observed at in-patient clinic for RA clinical assessment and revealing concomitant diseases (cardiovascular, gastrointestinal, liver, pulmonary, endocrine, blood). The activity of disease according to DAS28-ESR index in RA subgroups with different comorbidities was compared. The spectrum and used doses of anti-rheumatic medications (DMARD, biologics, GC) in these subgroups was analyzed in term to assess the RA rational treatment. <h3>Results:</h3> The majority (88.1%) of observed RA pts had concomitant condition. The most frequent associated diseases were: cardiovascular (AH, IHD, HF, AF) in 86.9% and gastrointestinal (gastritis, duodenitis, gastroduodenal ulcer, colitis) in 64.3% less common comorbidities were anemia (30.9%), liver and kidney abnormalities (hepatomegaly, steatohepatitis, CKD, pyelonephritis) in 25% and 12.5% respectively, endocrine (type 2 diabetes mellitus, thyroid disorders) in 16.7%. Multimorbidity determined as combination of different system disorders in the setting of RA was detected in 54.8% of RA pts. We found out significant difference in RA activity on the basis of DAS28 between RA subgroup without concomitant conditions (the 1<sup>st</sup>) on the one hand and RA subgroups with comorbidities (the 2<sup>nd</sup>) (t1=2.76, p&lt;0.01) or multimorbidities (t2=3.73, p&lt;0.01) on the other hand (tab.1). In RA with comorbidities/multimorbidities the mean doses of MTX and SSZ were lower than in RA without comorbidities, while the dose of GC and frequency of GC use was significantly higher in the 2<sup>nd</sup> and 3d groups (χ=4.25, 4.41 respectively). 55% of pts from the 1<sup>st</sup> group and only 19.6% of total amount of pts from the 2<sup>nd</sup> and 3<sup>d</sup> groups were treated with biologics (χ=5.67). <h3>Conclusion:</h3> Obtained data suggest that comorbidities have a negative impact on the severity of RA and can interfere in the implementation of T2T strategy in daily clinical practice. <h3>References:</h3> [1] Dougados M, Soubrier M, Antunez A, Balint P, Balsa A, Buch MH, et al. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis (2014) 73(1):62–8. doi:10.1136/annrheumdis-2013-204223 [2] Radner H. Multimorbidity in rheumatic conditions. Wien Klin Wochenschr (2016) 128(21–22):786–90. doi:10.1007/s00508-016-1090-x [3] Radner H, Yoshida K, Frits M, Iannaccone C, Shadick NA, Weinblatt M, et al. The impact of multimorbidity status on treatment response in rheumatoid arthritis patients initiating disease-modifying anti-rheumatic drugs. Rheumatology (Oxford) (2015) 54(11):2076–84. doi:10.1093/rheumatology/kev239 <h3>Disclosure of Interests:</h3> None declared