title: Comparisons between comorbid conditions and health care consumption in rheumatoid arthritis patients with or without biological disease-modifying anti-rheumatic drugs: a register-based study.
abstract: Symptoms and prognosis of patients with rheumatoid arthritis (RA) have improved with more intensive therapy, including the biological disease-modifying anti-rheumatic drugs (bDMARDs). Real life data concerning how comorbidities are distributed among patients treated or not treated with bDMARDs are scarce. Our objective was to investigate differences in comorbidity and health care consumption in RA patients, with and without bDMARDs.
  
  
  
  This cross-sectional study was performed in the Southwestern part of Sweden. Patients, aged ≥ 18 years and diagnosed with RA in secondary health care during 2009-2010, were identified in the regional health care database. Aggregated data of comorbidity and health care consumption were retrieved between 2006 and 2010. RA patients treated with bDMARDs on 31st December 2010 were identified in the Swedish Rheumatology Quality Register (SRQ), which includes the biologics register Anti-Rheumatic Therapy in Sweden (ARTIS). Descriptive, comparative, univariate and multiple logistic regression analyses were used to identify factors associated with bDMARDs.
  
  
  
  Seven thousand seven hundred and twelve (7712) RA patients were identified (age 64.8 ± 14.9 years, women 74.3%), of whom 1137 (14.7%) were treated with bDMARDs. Overall, the most common comorbidities were infections (69.2%), hypertension (41.1%), chronic respiratory disease (15.3%), ischemic heart disease (14.0%) and malignancy (13.7%). Patients without bDMARDs were older and had more comorbidity. In the multiple logistic regression analysis, older age, cerebrovascular and chronic respiratory disease, heart failure, depression and malignancy were all associated with no present bDMARDs. Infections were associated with bDMARDs. Patients treated with bDMARDs consumed more secondary outpatient care but less visits in primary health care compared to patients without bDMARDs.
  
  
  
  Patients treated with bDMARDs versus no bDMARDs were younger and had significantly lower period prevalence for most common comorbidities, with the exception of infections. Differences in comorbidities between RA patients with or without bDMARDs should be taken into consideration when evaluating effectiveness and safety of bDMARDs in ordinary care.
authors.affiliation: Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Box 480, S-405 30, Gothenburg, Sweden. karin.si.bengtsson@vgregion.se.
authors.forename: Karin
authors.identifier: 0000-0001-5154-0144
authors.initials: K
authors.lastname: Bengtsson
authors.affiliation: Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Box 480, S-405 30, Gothenburg, Sweden.
authors.forename: Lennart T H
authors.initials: LT
authors.lastname: Jacobsson
authors.affiliation: Department of Rheumatology, Skövde Hospital (Kärnsjukhuset), Skövde, Sweden.
authors.forename: Barbro
authors.initials: B
authors.lastname: Rydberg
authors.affiliation: Department of Rheumatology, Södra Älvsborgs Hospital, Borås, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Kvist
authors.affiliation: Department of Rheumatology, Uddevalla Hospital, Uddevalla, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Torstenson
authors.affiliation: Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Box 480, S-405 30, Gothenburg, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Dehlin
authors.affiliation: Department of Rheumatology, Alingsås Hospital, Alingsås, Sweden.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Hilme
authors.affiliation: Regional Health Care, Västra Götaland, Gothenburg, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Lindhé
authors.affiliation: Department of Clinical Pharmacology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Susanna Maria
authors.initials: SM
authors.lastname: Wallerstedt
authors.affiliation: Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Box 480, S-405 30, Gothenburg, Sweden.|Departments of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Forsblad-d'Elia
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology*; D001688:Biological Products / Q000627:therapeutic use*; D002908:Chronic Disease / Q000453:epidemiology; D003141:Communicable Diseases / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology; D009369:Neoplasms / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
keywords: Biologic agents; Biological therapy; Comorbidity; DMARDs; Health care consumption; Rheumatoid arthritis; bDMARDs