title: Cardiovascular Comorbidities Relate More than Others with Disease Activity in Rheumatoid Arthritis.
abstract: OBJECTIVE
  To explore the influence of comorbidities on clinical outcomes and disease activity in rheumatoid arthritis (RA).
  
  
  METHODS
  In patients included in the cross-sectional observational multicenter international study COMORA, demographics, disease characteristics and comorbidities (hypertension, diabetes, hyperlipidemia, renal failure, ischemic heart disease, stroke, cancer, gastro-intestinal ulcers, hepatitis, depression, chronic pulmonary disease, obesity) were collected. Multivariable linear regression models explored the relationship between each comorbidity and disease activity measures: 28-swollen joint count (SJC), 28-tender joint count (TJC), erythrocyte sedimentation rate (ESR), patient's and physician's global assessment (PtGA, PhGA), patient reported fatigue and 28-Disease Activity Score (DAS28). Results are expressed as mean difference (MD) adjusted for the main confounders (age, gender, disease characteristics and treatment).
  
  
  RESULTS
  A total of 3,920 patients were included: age (mean ±SD) 56.27 ±13.03 yrs, female 81.65%, disease duration median 7.08 yrs (IQR 2.97-13.27), DAS28 (mean ±SD) 3.74 ± 1.55. Patients with diabetes had more swollen and tender joints and worse PtGA and PhGA (MD +1.06, +0.93, +0.53 and +0.54, respectively). Patients with hyperlipidemia had a lower number of swollen and tender joints, lower ESR and better PtGA and PhGA (MD -0.77, -0.56, -3.56, -0.31 and -0.35, respectively). Patients with history of ischemic heart disease and obese patients had more tender joints (MD +1.27 and +1.07) and higher ESR levels (MD +5.64 and +5.20). DAS28 is influenced exclusively by cardiovascular comorbidities, in particular diabetes, hyperlipidemia, ischemic heart disease and obesity.
  
  
  CONCLUSIONS
  Cardiovascular comorbidities relate more than others with disease activity in RA. Diabetes and hyperlipidemia in particular seem associated with higher and lower disease activity respectively influencing almost all considered outcomes, suggesting a special importance of this pattern of comorbidities in disease activity assessment and clinical management.
authors.affiliation: Department of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Crepaldi
authors.affiliation: Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Scirè
authors.affiliation: Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.
authors.forename: Greta
authors.initials: G
authors.lastname: Carrara
authors.affiliation: Department of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Garifallia
authors.initials: G
authors.lastname: Sakellariou
authors.affiliation: Department of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Caporali
authors.affiliation: Mohammed V Souissi University, Faculty of Medicine, Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Rabat, Morocco.
authors.forename: Ihsane
authors.initials: I
authors.lastname: Hmamouchi
authors.affiliation: Rheumatology B Department, Hospital Cochin, Medicine Faculty, Paris-Descartes University, Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.affiliation: Department of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Carlomaurizio
authors.initials: C
authors.lastname: Montecucco
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D002318:Cardiovascular Diseases / Q000150:complications*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005221:Fatigue; D005260:Female; D006801:Humans; D007391:International Cooperation; D007596:Joints / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome