Comorbidity Burden Increases 3 Years After Diagnosis With Psoriatic Arthritis, Rheumatoid Arthritis

Compared with controls, patients with psoriatic arthritis presented more often with depression at baseline and patients with rheumatoid arthritis had a higher incidence of cardiovascular comorbidity after 3 years.

For patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA), but not for those with spondyloarthritis (SpA), the comorbidity burden increases 3 years after diagnosis, according to a study published in RMD Open.1 Compared with controls, patients with PsA presented more often with depression at baseline and patients with RA had a higher incidence of cardiovascular comorbidity after 3 years.

“Rheumatologists should consider management of comorbidities as 1 of the primary tasks involved in the care of a newly diagnosed patient with an inflammatory rheumatic disease,” noted Diederik De Cock, PhD, skeletal biology and engineering research center at KU Leuven in Leuven, Belgium, and colleagues. “Collaboration with other health care providers including nurses, primary care providers, and other specialists is key to optimizing a holistic management for every patient.”

In this general practice (GP) registry-based study in Belgium, the researchers aimed to compare the 3-year (1999-2012) comorbidity incidence and pain medication prescription in 167 patients diagnosed with PsA, 738 with RA, and 229 with SpA compared with controls. The comorbidity burden was measured by the Rheumatic Diseases Comorbidity Index (RDCI) and electronically GP-prescribed drugs were registered.

Results showed that the patients with PsA or RA had comparable median RDCI scores at baseline, but higher scores at year 3 compared with controls (PsA: p=0.008; RA: p=0.010). At baseline, depression was more prevalent in patients with PsA compared with controls (p<0.003), with one-fifth of patients burdened by depressive symptoms. Meanwhile, patients with RA had a higher 3-year incidence of cardiovascular disease including myocardial infarction than controls (p<0.035).

Speaking to Rheumatology Network, De Cock said that “PsA patients had by far the most different comorbidity profile compared to their controls. Although no statistical difference was seen, indications for higher incidence for malignancies and cardiovascular comorbidities were clear.” He suggested that depression was more prevalent in PsA patients versus controls, as patients with PsA “struggle with their skin rashes and feel ashamed for it.”

Further, compared with controls, patients with PsA, RA, or SpA were prescribed more pain medications, including opioids but excluding tramadol. However, the prescription rate by GPs of opioids was high for both the patient and control populations.

“The results underline to treat the patient as a whole and to take these comorbidities into account, especially with high co-medication rates, not always related to rheumatic and musculoskeletal diseases,” De Cock stated.

Reference:

Stouten V, Pazmino S, Verschueren P, et al

Comorbidity burden in the first three years after diagnosis in patients with rheumatoid arthritis, psoriatic arthritis or spondyloarthritis: a general practice registry-based study

RMD Open 2021;7:e001671. doi: 10.1136/rmdopen-2021-001671