Comorbidities and the Risk of Falls in RA

Rheumatoid arthritis is a complex condition associated with a host of comorbidities that can lead to functional impairment. In this article, Rheumatology Network examines common comorbidities and the role of comorbidities in limiting mobility.

Mayo Clinic review breaks down common comorbidities in RA

Emerging evidence points to poorer outcomes after comorbidities in people with rheumatoid arthritis compared with the general population. This is the sobering conclusion to a 2009

review

of epidemiological studies on the incidence, prevalence, mortality and comorbidity of rheumatic diseases.

Many comorbidities have been linked to rheumatoid arthritis, in particular, anemia, osteoporosis and bacterial infection. Others that have a moderate relationship with rheumatoid arthritis include lymphoma, gastrointestinal ulceration, myocardial infarction and heart failure.

Comorbidities greatly influence a patient's quality of life, treatment effectiveness and rheumatoid arthritis prognosis, wrote the authors, led by Sherine E Gabriel of Mayo Clinic in Rochester, Minn. The researchers found that the average rheumatoid arthritis patient has approximately 1.6 comorbidities, and the number increases with age.

The more comorbidities, the more complex patient care becomes, making diagnosis and treatment decisions more challenging. Comorbid illnesses also add to medical costs, disability, and risk for mortality. “Therefore, it is important to recognize such illnesses and to account for them in the care of the individual patient,” they stated.

The authors describe common comorbidities by disease state. Here are the highlights:

• Cardiovascular diseases. Ischemic heart disease rates are significantly higher in rheumatoid arthritis patients than controls, and rheumatoid arthritis  patients are at a higher risk for having a hospital or silent myocardial infarction.  Emerging studies also indicate rheumatoid arthritis patients are at increased risk for heart failure. These comorbid cardiovascular conditions may present in an atypical fashion, the authors wrote.
• Malignancy. After cardiovascular disease, cancer is the second most common cause of mortality among rheumatoid arthritis patients. Lymphoma is increased in rheumatoid arthritis, and is related to the severity of the disease itself. An increase in lung cancer among rheumatoid arthritis patients is likely linked, in part, to their excess risk for smoking.
• Lung disease. The prevalence of interstitial lung disease (ILD) among rheumatoid arthritis patients ranges from 19% to 44%. Almost all disease-modifying anti-rheumatic drugs have been linked to lung disease and/or ILD, the authors wrote.
• Infection. Rheumatoid arthritis appears to increase the risk for infections, which are more common in more active and severe rheumatoid arthritis. In particular, corticosteroid use is associated with increased risk of serious bacterial infection.
• GI ulcer disease. The risk for GI ulceration has also been associated with corticosteroid use and might be increased further by concomitant use of non-steroidal anti-inflammatory drugs.

The authors believe their review underscores the complexity of rheumatic diseases and “highlight the key role of epidemiological research in understanding these intriguing conditions.”

New study shows comorbidities affect mobility, leads to falls

The presence of comorbidities are the main predictors of functional capacity loss in rheumatoid arthritis patients who are at least 65 years old, write the authors of a study appearing in the July issue of the Brazilian Journal of Rheumatology.mortality.

Rheumatoid arthritis can lead to functional impairment affecting daily living, muscle strength, mobility and increasing the risk of falls. In fact, an earlier study reported that after a 15-year follow-up, 81 percent of rheumatoid arthritis patients presented comorbidities associated with loss of functional capacity and mortality.

​“There has been a growing interest from researchers to study comorbidities and their impact on different clinical outcomes in rheumatoid arthritis, such as hospitalization, mortality, functional capacity and medical costs,” wrote the authors of the new study which was led by Wanessa Vieira Marques of the Universidade Federal de Goiás, Brazil.

In this cross-sectional  study, researchers investigated the association between mobility limitation, functional disability and comorbidities  as measured by total number of comorbidities, Charlson comorbidity index (CCI) and functional comorbidity index (FCI). It is the first-known study to examine the association between comorbidities and mobility that includes the time spent to perform the sit-to-stand (STS) test and the Timed Up and Go Test (TUG).

The study included 60 patients (mean age 59) who were followed over 11 months. Researchers found that comorbidities accounted for 32.9% of the variability of the Health Assessment Questionnaire score (adjusted R2= 0.329) when factoring in functional disability.

Of 27 comorbidities reported by patients, osteoporosis was the most common with 28 (47%) of 60 patients reporting they had osteoporosis, which is a concern due to the possibility of increased fracture risk.

“The fact that rheumatoid arthritis is responsible for a general impairment in terms of functional status of patients, causing impairment in activities of daily living, muscle strength and mobility and increasing the risk of falls, emphasizes the importance of mobility studies in this population,” the authors wrote. “In addition, the study also draws attention to the use of FCI (functional comorbidity index) as an alternative tool to evaluate the impact of comorbidities on functionality of patients with RA.”

References:

Sherine E Gabriel and Kaleb Michaud.

"Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases,"

Arthritis Research & Therapy

2009, 11:229  doi:10.1186/ar2669 Marquesa WV, Cruzb VA, et al.,

"The impact of comorbidities on the physicalfunction in patients with rheumatoid arthritis,"

Brazilian Journal of Rheumatology

, online 16 July 2015, doi: 10.1016 / j.rbre.2015.07.009