abstract details

The summaries are free for public use. ARTHROS will continue to add and archive summaries of articles deemed relevant to ARTHROS by our Faculty.

The roles of post-diagnosis accumulation of morbidities and lifestyle changes on excess total and cause-specific mortality risk in rheumatoid arthritis

Author

Yoshida K1,2, Lin TC1, Wei M3, Malspeis S1, Chu SH1,2,4, Camargo CA2,4,5, Raby BA2,6,7, Choi HK2,8, Tedeschi SK1,2, Barbhaiya M9,10, Lu B1,2, Costenbader KH1,2, Karlson EW1,2, Sparks JA1,2. Arthritis Care Res (Hoboken). 2019 Dec 7. doi: 10.1002/acr.24120. [Epub ahead of print]

Author Information

1 Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, United States.

2 Harvard Medical School, Boston, Massachusetts, United States.

3 Division of General Medicine and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States.

4 Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States.

5 Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States.

6 Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States.

7 Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, United States.

8 Division of Rheumatology, Massachusetts General Hospital, Boston, Massachusetts, United States.

9 Division of Rheumatology, Hospital for Special Surgery, New York City, New York, United States.

10 Weill Cornell Medical College, New York City, New York, United States.

Abstract

OBJECTIVE: 

To elucidate how post-diagnosis multimorbidity and lifestyle changes contribute to the excess mortality of rheumatoid arthritis (RA).

METHODS: 

We performed a matched cohort study among women in the Nurses' Health Study (1976-2018). We identified women with incident RA and matched each by age and year to 10 non-RA comparators at RA diagnosis index date. Specific causes of death were ascertained via death certificates and medical record review. Lifestyle and morbidity factors were reported biennially; 61 chronic conditions were combined into the Multimorbidity Weighted Index (MWI). After adjusting for baseline confounders, we used inverse probability weighting analysis to examine the mediating influence of post-index MWI and lifestyle factors on total, cardiovascular, and respiratory mortality, comparing women with RA to their matched comparators.

RESULTS: 

We identified 1,007 incident RA patients and matched to 10,070 non-RA comparators. Adjusting for pre-index confounders, RA patients had elevated HRs and 95%CIs for total (1.46 [1.32,1.62]), cardiovascular (1.54 [1.22,1.94]), and respiratory (2.75 [2.05,3.71]) mortality, compared to non-RA comparators. Adjusting for post-index lifestyle factors (physical activity, BMI, diet, smoking) attenuated but did not substantially account for this excess RA mortality. After additional adjustment for post-index MWI, RA patients had HRs and 95%CIs of 1.18 [1.05,1.32] for total, 1.19 [0.94,1.51] for cardiovascular, and 1.93 [1.42,2.62] for respiratory mortality.

CONCLUSION: 

We found that MWI substantially accounted for the excess total and cardiovascular mortality among women with RA. This finding underscores the importance of monitoring for the total disease burden as a whole in monitoring RA patients.