title: Disease characteristics and treatment patterns in veterans with rheumatoid arthritis and concomitant hepatitis C infection.
abstract: OBJECTIVE
  To assess disease characteristics, disease activity, and treatment patterns in rheumatoid arthritis (RA) patients with comorbid hepatitis C virus (HCV) infection.
  
  
  METHODS
  RA patients with concomitant HCV were identified within the Veterans Affairs Rheumatoid Arthritis Registry. HCV was defined as at least 1 diagnostic code present in medical record databases. Generalized estimating equations in linear regression models compared component and composite measures of disease activity between HCV-positive and HCV-negative patients over the study period, accounting for within-subject correlations. Similar analysis of pharmacy databases evaluated medication use within each group.
  
  
  RESULTS
  Ninety-two of 1,706 registry participants (5.1%) were identified with concomitant HCV. At enrollment, HCV-positive patients were younger (mean ± SD 61.7 ± 7.1 years versus 67.5 ± 11.2 years; P < 0.001), more often African American (35% versus 15%; P < 0.001), and smokers (48% versus 26%; P < 0.001). In unadjusted and adjusted analyses incorporating all study visits, patient-reported outcomes (pain, tender joints, and patient global scores) were higher in HCV-positive patients, contributing to higher disease activity scores. There was no difference in physician-reported outcomes (swollen joints or physician global scores). HCV-positive patients had lower C-reactive protein levels (β -0.30 [95% confidence interval (95% CI) -0.53, -0.07], P = 0.01). Over all visits, HCV-positive patients were less likely to receive methotrexate (odds ratio [OR] 0.27 [95% CI 0.17, 0.40], P < 0.001), and more likely to receive prednisone (OR 1.41 [95% CI 1.02, 1.97], P = 0.04) and anti-tumor necrosis factor α (anti-TNFα) therapies (OR 1.51 [95% CI 1.04, 2.19], P = 0.03).
  
  
  CONCLUSIONS
  RA patients with concomitant HCV have higher disease activity scores, driven primarily by higher patient-reported measures. HCV-positive patients were more likely to be treated with prednisone and anti-TNFα therapies and less likely to receive methotrexate compared to HCV-negative patients.
authors.affiliation: Philadelphia VA Medical Center, Pennsylvania, and University of Pennsylvania.
authors.forename: Ruchika
authors.initials: R
authors.lastname: Patel
authors.forename: Ted R
authors.initials: TR
authors.lastname: Mikuls
authors.forename: John S
authors.initials: JS
authors.lastname: Richards
authors.forename: Gail
authors.initials: G
authors.lastname: Kerr
authors.forename: Grant W
authors.initials: GW
authors.lastname: Cannon
authors.forename: Joshua F
authors.initials: JF
authors.lastname: Baker
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014728:Veterans
chemical_list: D018501:Antirheumatic Agents; D000998:Antiviral Agents; D014409:Tumor Necrosis Factor-alpha; D011241:Prednisone; D008727:Methotrexate