KU Leuven Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Leuven, Belgium.
Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium.
Rheumatology (Oxford). 2021 Aug 2;60(8):3699-3708. doi: 10.1093/rheumatology/keaa841.
To quantify the prevalence of co-morbidities in patients with early RA and determine their prognostic value for effectiveness outcomes in a randomized trial.
We included patients from the 2-year pragmatic randomized CareRA trial, who had early RA (diagnosis < 1 year), were DMARD naïve and then treated-to-target with different remission induction schemes. Prevalence of co-morbidities was registered at baseline and the Rheumatic Diseases Comorbidity Index (RDCI; range 0-9) was calculated. We tested the relation between baseline RDCI and outcomes including disease activity (DAS28-CRP), physical function (HAQ index), quality of life (SF-36 domains) and hospitalizations over 2 years, using linear mixed models or generalized estimating equations models.
Of 379 included patients, 167 (44%) had a RDCI of minimum 1. RDCI scores of 1, 2 or ≥3 were obtained in 65 (17%), 70 (19%), and 32 (8%) participants, respectively. The most frequent co-morbidity was hypertension (22%). Patients with co-morbidities had significantly higher HAQ (β = 0.215; 95% CI: 0.071, 0.358), DAS28-CRP (β = 0.225; 95% CI: 0.132, 0.319) and lower SF-36 physical component summary scores (β =-3.195; 95% CI: -4.844, -1.546) over 2 years than patients without co-morbidities, after adjusting for possible confounders including disease activity and randomized treatment. Patients with co-morbidities had over time lower chances of achieving remission (OR = 0.724; 95% CI: 0.604, 0.867) and a higher risk of hospitalization (OR = 3.725; 95% CI: 2.136, 6.494).
At disease onset, almost half of RA patients had at least one clinically important co-morbidity. Having co-morbidities was associated with worse functionality and disease activity outcomes over 2 years, despite intensive remission induction treatment.
Clinical trials NCT01172639.
定量评估早期类风湿关节炎（RA）患者共病的患病率，并确定其在一项随机试验中对有效性结局的预后价值。
我们纳入了来自为期 2 年的实用随机 CareRA 试验的患者，这些患者具有早期 RA（诊断时间<1 年）、未接受过 DMARD 治疗，随后根据不同的缓解诱导方案进行达标治疗。在基线时记录共病的患病率，并计算风湿病共病指数（RDCI；范围 0-9）。我们使用线性混合模型或广义估计方程模型，检测基线 RDCI 与包括疾病活动度（DAS28-CRP）、身体功能（HAQ 指数）、生活质量（SF-36 各维度）和 2 年内住院治疗情况在内的结局之间的关系。
在纳入的 379 例患者中，有 167 例（44%）RDCI 至少为 1。65 例（17%）、70 例（19%）和 32 例（8%）患者的 RDCI 评分分别为 1、2 和≥3。最常见的共病是高血压（22%）。有共病的患者在 2 年内的 HAQ（β=0.215；95%CI：0.071，0.358）、DAS28-CRP（β=0.225；95%CI：0.132，0.319）和 SF-36 身体成分综合评分（β=-3.195；95%CI：-4.844，-1.546）均显著更高，而调整疾病活动度和随机治疗等可能的混杂因素后，无共病的患者在这几个方面的评分均显著更低。有共病的患者随着时间的推移，实现缓解的几率更低（OR=0.724；95%CI：0.604，0.867），住院的风险更高（OR=3.725；95%CI：2.136，6.494）。
在发病时，近一半的 RA 患者至少有一种具有临床重要意义的共病。尽管进行了强化缓解诱导治疗，但存在共病与 2 年内功能和疾病活动度结局更差相关。
Clinical trials NCT01172639。
