Each comorbidity lowers odds of remission
When relative burden of comorbidities was assessed by RxRisk score, a validated medication-based measure of chronic disease that recognizes 46 categories of chronic conditions, there was about a 5% lower odds ratio for each RxRisk unit of increase in comorbidity. The relationship was consistent across various cohorts of patients evaluated, according to Dr. England.
When looking for patterns of comorbidities in these large datasets using machine learning, Dr. England reported that there were “striking” relationships between organ systems. This included a pattern of cardiometabolic multimorbidity, cardiopulmonary multimorbidity, and mental health and chronic pain multimorbidity. Surprisingly, the same patterns could be identified in those with or without RA, but the prevalence differed.
“RA was closely associated with all of these different multimorbidity patterns, but the odds of having these patterns were one- to threefold greater,” Dr. England reported.
“The multimorbidity pattern most closely associated with RA was mental health and chronic pain,” he added, noting that the same results were observed across the datasets evaluated.
The implication of this work is that multimorbidity exerts an adverse effect on the course of RA and might be an appropriate target of therapies to improve RA outcomes. Although Dr. England called for better tools to measure multimorbidity and consider how it can be addressed systematically in RA patients with the intention of improving RA control, he believes this is an important direction of research.
“What our data show is that we need to begin to think more holistically about these other diseases in RA patients,” he said.
Others support targeting of comorbidities
Vanessa L. Kronzer, MD, a rheumatology fellow at Mayo Clinic, Rochester, Minn., agreed. An author of a study that identified 11 comorbidities significantly associated with RA, either as conditions that predispose to RA or that commonly develop in patients with RA, Dr. Kronzer has drawn the same conclusion in regard to targeting comorbidities in the RA patient.
“Based on mounting evidence that multimorbidity is associated with RA and RA disease activity, taking a broader view of the patient as a whole and his or her comorbidities may help us to not only predict RA but also achieve over disease-specific goals,” Dr. Kronzer said in an interview.
“I suspect that certain comorbidities, perhaps depression as an example, may play a particularly strong role in perpetuating high RA disease activity,” she added. She considers this a ripe area of study for improving clinical strategies in RA.
“Finding out which ones [perpetuate RA] and targeting them could be a reasonable approach to moving forward,” Dr. Kronzer said.
Dr. England and Dr. Kronzer reported having no potential conflicts of interest.