Multimorbidity Predicts High Mortality and Poor Quality of Life in Patients With Rheumatoid Arthritis

senior woman weathered old wrinkled hands with IV drip on wrist and medical equipment oxygen sensor (pulse oximeter) on finger, is a patient in ER emergency room hospital bed
Study authors reviewed the literature to determine the effect of multimorbidity on all-cause mortality, functional status, and quality of life in RA.

Among patients with rheumatoid arthritis (RA), the presence of 2 or more long-term conditions, or multimorbidity, is associated with increased mortality and poorer functional status and quality of life (QOL), according to a systematic review and meta-analysis published in Arthritis Care & Research.

Previous studies have shown that patients with RA have 1.6 additional long-term conditions. While there are data on RA and 1 comorbidity, the objective of the current review was to determine the effect of multimorbidity on all-cause mortality, functional status, and QOL.

Using 6 electronic databases, including CINAHL, Cochrane Library, Embase, Medline, PsychINFO, and SCOPUS, the study authors extracted data from observational studies and performed a quality appraisal using the Cochrane-developed QUIPS tool.

From the initial literature search, the study authors identified 5343 papers and 19 studies, including 9 studies reporting on all-cause mortality, 3 reporting on functional status and QOL, and 6 reporting on functional status. All studies were conducted between 1985 and 2018, with number of participants ranging from 183 to 18,485 (mean age, 53.6-66.6 years; 60.0%-84.2% women).

Multimorbidity was associated with a significantly increased risk for all-cause mortality in patients with RA in 9 of 10 studies reporting all-cause mortality as an outcome. In addition, all 10 studies exploring the association between multimorbidity and functional status and QOL in patients with RA reported that multimorbidity predicted reduced functional status and impaired QOL. In all 10 studies, multimorbidity independently contributed to functional decline over time. Somatic and psychologic comorbidities were found to be risk factors for increased disability in patients with RA.

Using various instruments to determine QOL, the 3 studies that reported on QOL showed that multimorbidity was associated with significantly lower QOL. Psychologic comorbidity, especially depression, was associated with an increased risk for poor outcomes.

The current review had several limitations, including the clinical and methodologic heterogeneity of the included studies and the restriction of the studies to the English language.

“Health care professionals should pay close attention to multimorbidity when treating people with RA, with further research needed on the impact of concurrent mental health conditions,” the researchers concluded.


Canning J, Siebert S, Jani BD, Harding-Edger L, Kempe I, Mair FS, Nicholl BI. Examining the relationship between rheumatoid arthritis, multimorbidity and adverse health‐related outcomes: a systematic review. Arthritis Care Res (Hoboken). Published online March 1, 2021. doi:10.1002/acr.24587