Management of Multimorbidity Patterns May Improve Outcomes for Rheumatoid Arthritis

Focusing on the identification and management of mental health and substance abuse, cardiovascular, and chronic pain multimorbidity patterns among patients with rheumatoid arthritis (RA) may increase achievement of treatment goals and improve long-term patient outcomes, according to study findings published in Arthritis Care & Research.

Investigators aimed to determine whether long-term RA severity is associated with multimorbidity patterns.

A cohort study was conducted using the Veterans Affairs Rheumatoid Arthritis (VARA) registry that included patients with rheumatologist-confirmed RA with up to 5 years of follow-up.

Primary study outcomes included disease activity (assessed via the 28-Joint Disease Activity Score [DAS28]) and physical function (assessed via the Multidimensional Health Assessment Questionnaire [MDHAQ]).

A total of 2956 participants (11.8% women; 76.9% White; 79.3% current or former smokers) were included in the analysis.

Metabolic multimorbidity (64.0%) was the most frequent pattern, followed by chronic pain (48.4%), mental health and substance abuse (23.2%), and cardiovascular (12.4%) patterns.

Participants with chronic pain or mental health and substance abuse multimorbidity were younger and reported higher levels of education. Participants with cardiovascular multimorbidity had a longer duration of RA and were of more advanced age.

Nearly three-fourths of participants had at least 1 multimorbidity pattern, with 24.9% having 1 pattern, 26.0% having 2, 19.0% having 3, and 3.5% having all 4 patterns. 

Higher DAS28 scores were associated with mental health and substance abuse (β, 0.12; 95% CI, 0.00-0.23), cardiovascular (β, 0.25; 95% CI, 0.12-0.38), and chronic pain (β, 0.21; 95% CI, 0.11-0.31) patterns of multimorbidity.

Only chronic pain multimorbidity remained associated with higher DAS28 scores over the follow-up period (β, 0.16; 95% CI, 0.07-0.25), after adjusting for baseline DAS28 scores.

Higher MDHAQ scores were associated with the same multimorbidity patterns as DAS28 scores: mental health and substance abuse (β, 0.09; 95% CI, 0.03-0.15), cardiovascular (β, 0.11; 95% CI, 0.04-0.17), and chronic pain (β, 0.15; 95% CI, 0.10-0.20).

Only chronic pain multimorbidity remained associated with higher MDHAQ scores over the follow-up period (β, 0.09; 95% CI, 0.05-0.13), after adjusting for baseline MDHAQ scores.

No association was found between the metabolic pattern of multimorbidity with either DAS28 or MDHAQ scores over time.

Analysis revealed an association between DAS28/MDHAQ scores and the number of multimorbidity patterns present (P for trend <.001). The highest scores were found among patients with all 4 multimorbidity patterns (DAS28: β, 0.59; 95% CI, 0.36-0.83; MDHAQ: β, 0.27; 95% CI, 0.16-0.39).

Participants with only 1 multimorbidity pattern did not have higher DAS28 or MDHAQ scores vs participants with no multimorbidity patterns, though, participants with 2 or more multimorbidity patterns did have higher DAS28 and MDHAQ scores vs participants with no patterns.

This study was limited by the inability to evaluate the severity of conditions associated with multimorbidity patterns. Additional limitations included lack of analysis on how combinations of multimorbidity patterns may affect RA disease activity and functional status, as well as limited generalizability due to the majority male study population.  

The study authors concluded, “These findings illustrate the important differential associations of multimorbidity with RA-related outcomes and the potential for gains that could be realized by identifying and treating (or better, preventing) multimorbidity as part of holistic RA management.”

Disclosure: One or more study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.