From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.
A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre.
J Rheumatol. 2019 Jun;46(6):564-571. doi: 10.3899/jrheum.180668. Epub 2019 Jan 15.
To investigate the prevalence of comorbidities in a population-based cohort of persons with rheumatoid arthritis (RA) compared to matched controls and to examine their association with patient-reported outcomes in a survey sample.
Data of 96,921 persons with RA [International Classification of Diseases, 10th ed (ICD-10) M05/M06] and 484,605 age- and sex-matched controls without RA of a German statutory health fund were studied regarding 26 selected comorbidities (ICD-10). A self-reported questionnaire, comprising joint counts [(tender joint count (TJC), swollen joint count (SJC)], functional status (Hannover Functional Ability Questionnaire), effect of the disease (Rheumatoid Arthritis Impact of Disease), and well-being (World Health Organization 5-item Well-Being Index; WHO-5) was sent to a random sample of 6193 persons with RA, of whom 3184 responded. For respondents who confirmed their RA (n = 2535), associations between comorbidities and patient-reported outcomes were analyzed by multivariable linear regression.
Compared to controls, all investigated comorbidities were more frequent in persons with RA (mean age 63 yrs, 80% female). In addition to cardiovascular risk factors, the most common were osteoarthritis (44% vs 21%), depression (32% vs 20%), and osteoporosis (26% vs 9%). Among the survey respondents, 87% of those with 0-1 comorbidity but only 77% of those with ≥ 8 comorbidities were treated by rheumatologists. Increasing numbers of comorbidities were associated with poorer values for TJC, SJC, function, and WHO-5.
Compared to a matched population, persons with RA present with increased prevalence of numerous comorbidities. Patients with RA and multimorbidity are at risk of insufficient rheumatological care and poorer patient-reported outcomes.
调查类风湿关节炎（RA）患者人群与匹配对照人群相比共病的流行情况，并在调查样本中检查其与患者报告结果的相关性。
研究了德国法定健康基金中 96921 名 RA 患者[国际疾病分类，第 10 版（ICD-10）M05/M06]和 484605 名年龄和性别匹配的无 RA 对照者的 26 种选定共病（ICD-10）的数据。一项自我报告问卷，包括关节计数[（压痛关节计数（TJC），肿胀关节计数（SJC）]、功能状态（汉诺威功能能力问卷）、疾病的影响（类风湿关节炎疾病影响）和幸福感（世界卫生组织 5 项幸福感指数；WHO-5）被发送给 6193 名 RA 患者的随机样本，其中 3184 名患者做出了回应。对于确认患有 RA 的受访者（n=2535），通过多变量线性回归分析了共病与患者报告结果之间的关系。
与对照组相比，所有研究的共病在 RA 患者中更为常见（平均年龄 63 岁，80%为女性）。除了心血管危险因素外，最常见的是骨关节炎（44%比 21%）、抑郁症（32%比 20%）和骨质疏松症（26%比 9%）。在调查受访者中，87%的有 0-1 种共病的患者，但只有 77%的有≥8 种共病的患者接受了风湿病学家的治疗。共病数量的增加与 TJC、SJC、功能和 WHO-5 的值较差相关。
与匹配人群相比，RA 患者存在更多的共病患病率。RA 患者和多种共病患者存在接受不足的风湿病学治疗和较差的患者报告结果的风险。
