Original ArticlePrevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring in clinical practice: the spanish cohort of the COMORA studyPrevalencia de comorbilidades en artritis reumatoide y evaluación de su manejo en la clínica diaria: cohorte española del estudio COMORA
Introduction
Rheumatoid arthritis (RA) is a chronic inflammatory disease that can lead to progressive joint deformity, disability and reduction of life expectancy. In addition to the consequences of the disease itself, patients with RA are at increased risk of developing comorbidities that contribute substantially to increased disability and worsened quality of life. Cardiovascular, lung and gastrointestinal diseases, malignancies, infections, psychiatric disorders, and osteoporosis are found to be more prevalent in patients with RA compared to the general population, mainly due to concomitant medication such as immunosuppressive drugs, immunomodulatory effects of the disease, and increased prevalence of cardiovascular (CV) risk factors.1, 2
The prognosis of RA has improved over years because of the considerable change in the treatment, which includes tight control, aiming for low disease activity or remission. However, comorbidities in RA are often underrecognized despite their impact on disease activity and treatment outcomes3, and the awareness of most rheumatologists about their responsibility in their management.4 Several studies, such as the international COMORA on prevalence of comorbidities in RA and their monitoring, reported that compliance with guidelines on how to detect and manage these comorbidities is far from optimal, and varies between countries.5 To address this issue, EULAR has just published recommendations for comorbidity risk management in patients with RA,4 which are expected to be easily implemented in daily practice and will be of interest to evaluate in future studies. In Spain, the Society of Rheumatology of the Community of Madrid (SORCOM) has also developed practical recommendations to guide rheumatologists on optimal diagnosis and management.6
How Spain could better follow and implement such guidelines will be determined by the findings of the present study by showing the gap between recommendations and routine practices existing in 2012 in the management of RA comorbidities.
Using data from the Spanish cohort of COMORA study, we describe the prevalence of comorbidities in patients with RA in Spain and discuss their management and implications in clinical practice. The rationale for a national sub-analysis of COMORA was the need to emphasize the mistakes that rheumatologists do in identifying and monitoring these conditions in RA and clarify the role they should have in this area.
Section snippets
Study Design and Patients
COMORA was a cross-sectional, observational, multicenter, international study to evaluate variability in the prevalence of comorbidities and their risk factors between participating countries.5
The study was conducted according to the ethical principles of the Declaration of Helsinki and was approved by all local ethics review committees, with written informed consent obtained from all patients.
Eligible patients in COMORA were at least 18 years old, fulfilled the 1987 American College of
Patient Characteristics
Patient characteristics are shown in Table 1. Mean age was 58.5 years and mean disease duration was 10.3 years. Disease activity was low, as shown by the mean DAS28 of 3.3, and approximately 25% of patients were in remission (DAS28 <2.6). At the time of the study, 94.5% of patients were taking DMARDs and 36.5% biological agents.
Prevalence of Comorbidities and Risk Factors
Of the 200 patients analyzed in the Spanish cohort, 44 (22%) had at least one comorbidity. This prevalence rate resulted from the exclusion of depression from the
Discussion
This study shows that prevalence of comorbidities and CV risk factors in patients with established and advanced RA is relatively high in Spain, and evaluation of their monitoring is suboptimal despite being a country with an effective and accessible health system. The rate of 22% of at least one comorbidity found is lower as in other studies,9 but precisely this possible underestimation reflects their inadequate screening in RA. Indeed, if adequate screening for depression had been included in
Protection of human and animal subjects
The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).
Confidentiality of data
The authors declare that they have followed the protocols of their work center on the publication of patient data.
Right to privacy and informed consent
The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in
Source of Funding
This study was conducted with the support of an unrestricted grant from Roche Ltd.
Conflict of Interests
A.B. has received research grants from Roche, MSD, Pfizer, Abbvie, BMS and UCB. He is consultant and a member of speakers’ bureaus for Pfizer and has received speaker honoraria from Pfizer, Roche, MSD, Pfizer, Abbvie, BMS and UCB. L.L.O. has received grant for Roche and payment for lectures from Roche and Abbvie. M.A.L. has received payment for consultancy, lectures and board membership from Roche, Abbvie, BMS and MSD. C.O.C. has received grant from Roche and payment for lectures from UCB.
Acknowledgements
The authors would like to acknowledge the patients and doctors who participated in the study and the COMORA Committee for their support, especially Dr. Dougados, who was the principal investigator for the study. Medical writing assistance was provided by Isabel Caballero at Dynamic Science S.L. during the preparation of this article. Responsibility for opinions, conclusions and interpretation of data lies with the authors.
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