Multiple Chronic Conditions Tied to Poor Prognosis in RA
In patients with rheumatoid arthritis (RA), the presence of multiple chronic conditions was associated with an increased likelihood of disease flare and reduced odds of achieving remission.
METHODOLOGY:
Researchers conducted a retrospective, population-based study to investigate how multiple chronic conditions and adverse social determinants of health influence disease activity in patients with RA.
They analyzed the data of 659 patients with incident RA diagnosed between January 1999 and December 2014 (median age, 55.3 years; 69.7% women); each participant was required to have complete medical history of at least 1 year.
A list of 55 chronic medical conditions was used to identify multimorbidity (two or more conditions) and substantial multimorbidity (five or more conditions); the burden of adverse social determinants of health was assessed using the Area Deprivation Index and Social Vulnerability Index, considering factors such as socioeconomic status, housing quality, and education, among others.
Flare was identified as a worsening of disease requiring initiation, change, or escalation of treatment; remission was identified as having no more than one tender or swollen joint and normal inflammatory markers
The patients were followed for a median duration of 10.3 years and had a median number of 13 RA-related visits during the follow-up period.
TAKEAWAY:
Among the participants, 73.3% of patients had multimorbidity and 36.1% had substantial multimorbidity.
Patients with multimorbidity had 29% higher odds of an RA-related visit for disease flare and those with substantial multimorbidity had 26% higher odds (P < .05 for both); multimorbidity and substantial multimorbidity were also associated with significantly lower odds of a visit due to remission (odds ratios, 0.66 and 0.67, respectively; P < .05 for both).
Each 0.1 increase in the Social Vulnerability Index above 0.3 was associated with 8% lower odds of achieving remission (P < .05).
Female sex, current smoking, younger age, and shorter disease duration were associated with higher odds of a flare visit; on the contrary, male sex, never smoking, and longer disease duration were associated with higher odds of a remission visit. Seropositivity showed no significant association with either outcome.
IN PRACTICE:
'Multimorbidity shows potential to act as a prognostic factor for RA disease activity and can be readily adapted to real-world clinical settings. Increased attention to multimorbidity would help identify patients at risk of poor disease control, signaling to clinicians to consider more aggressive intervention early on,' the authors of the study wrote.
SOURCE:
This study was led by Daniel Montes, MD, Mayo Clinic, Rochester, Minnesota. It was published online on August 5, 2025, in RMD Open.
LIMITATIONS:
This retrospective study relied on diagnostic codes for identifying comorbidities. The use of disease-modifying antirheumatic drugs could not be accounted for. The study population was predominantly White (88%), limiting generalizability.
DISCLOSURES:
This study was supported by grants from the National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, and National Institute on Aging. One author reported receiving intellectual property/patents from Girhilet, NLC Health Ventures, and Remission Medical and grant/research support from Pfizer.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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