Comorbidities and treatment patterns in early rheumatoid arthritis: a nationwide Swedish study
Objective To examine how comorbidities in patients with early rheumatoid arthritis (RA) associate with use of different disease-modifying antirheumatic drugs (DMARDs).Methods We used Swedish nationwide clinical and quality registers to collect comorbidity data for patients diagnosed with RA during 2...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-12-01
|
| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/8/2/e002700.full |
| _version_ | 1827908484979490816 |
|---|---|
| author | Johan Askling Saedis Saevarsdottir Helga Westerlind Bénédicte Delcoigne Liselotte Tidblad |
| author_facet | Johan Askling Saedis Saevarsdottir Helga Westerlind Bénédicte Delcoigne Liselotte Tidblad |
| author_sort | Johan Askling |
| collection | DOAJ |
| description | Objective To examine how comorbidities in patients with early rheumatoid arthritis (RA) associate with use of different disease-modifying antirheumatic drugs (DMARDs).Methods We used Swedish nationwide clinical and quality registers to collect comorbidity data for patients diagnosed with RA during 2006–2019 (n=13 505). We compared the use of DMARDs at diagnosis and after 1 year, in relation to comorbidity categories 5 years prior to RA diagnosis and overall comorbidity burden. For each comorbidity category, we also calculated adjusted ORs of being on treatment with other (or no) DMARDs compared with methotrexate (MTX) monotherapy 1 year after RA diagnosis.Results At RA diagnosis, 68% (n=9178) of all patients were treated with MTX monotherapy, with the lowest proportion in patients with chronic kidney (CKD, 48%, n=50) and respiratory diseases (57%, n=413). At 1 year, most patients still received MTX monotherapy (<11% decrease, across all comorbidity categories). At 1 year, 13% received biological/targeted synthetic DMARDs, with the lowest proportion among patients with malignant diseases (OR=0.69, 95% CI=0.51 to 0.95). Being without DMARD at 1 year was more common among patients with CKD (OR=3.25, 95% CI=2.20 to 4.81), respiratory diseases (OR=1.83, 95% CI=1.32 to 2.53) or a history of hospitalisation due to infection (OR=1.47, 95% CI=1.23 to 1.75), and among patients with higher comorbidity burden and older age.Conclusion In a nationwide setting with universal healthcare, most comorbid conditions do not limit the initiation or continuation of MTX or other DMARDs in early RA, although patients with certain comorbid conditions, higher comorbidity burden and higher age were somewhat less intensively treated. |
| first_indexed | 2024-03-13T01:23:25Z |
| format | Article |
| id | doaj.art-8a290a57a3374ce3809760ed6ddea65f |
| institution | Directory Open Access Journal |
| issn | 2056-5933 |
| language | English |
| last_indexed | 2024-03-13T01:23:25Z |
| publishDate | 2022-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj.art-8a290a57a3374ce3809760ed6ddea65f2023-07-04T18:00:06ZengBMJ Publishing GroupRMD Open2056-59332022-12-018210.1136/rmdopen-2022-002700Comorbidities and treatment patterns in early rheumatoid arthritis: a nationwide Swedish studyJohan Askling0Saedis Saevarsdottir1Helga Westerlind2Bénédicte Delcoigne3Liselotte Tidblad42 Rheumatology, Karolinska University Hospital, Stockholm, SwedenFaculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland2 Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, SwedenDepartment of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, SwedenDivision of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, SwedenObjective To examine how comorbidities in patients with early rheumatoid arthritis (RA) associate with use of different disease-modifying antirheumatic drugs (DMARDs).Methods We used Swedish nationwide clinical and quality registers to collect comorbidity data for patients diagnosed with RA during 2006–2019 (n=13 505). We compared the use of DMARDs at diagnosis and after 1 year, in relation to comorbidity categories 5 years prior to RA diagnosis and overall comorbidity burden. For each comorbidity category, we also calculated adjusted ORs of being on treatment with other (or no) DMARDs compared with methotrexate (MTX) monotherapy 1 year after RA diagnosis.Results At RA diagnosis, 68% (n=9178) of all patients were treated with MTX monotherapy, with the lowest proportion in patients with chronic kidney (CKD, 48%, n=50) and respiratory diseases (57%, n=413). At 1 year, most patients still received MTX monotherapy (<11% decrease, across all comorbidity categories). At 1 year, 13% received biological/targeted synthetic DMARDs, with the lowest proportion among patients with malignant diseases (OR=0.69, 95% CI=0.51 to 0.95). Being without DMARD at 1 year was more common among patients with CKD (OR=3.25, 95% CI=2.20 to 4.81), respiratory diseases (OR=1.83, 95% CI=1.32 to 2.53) or a history of hospitalisation due to infection (OR=1.47, 95% CI=1.23 to 1.75), and among patients with higher comorbidity burden and older age.Conclusion In a nationwide setting with universal healthcare, most comorbid conditions do not limit the initiation or continuation of MTX or other DMARDs in early RA, although patients with certain comorbid conditions, higher comorbidity burden and higher age were somewhat less intensively treated.https://rmdopen.bmj.com/content/8/2/e002700.full |
| spellingShingle | Johan Askling Saedis Saevarsdottir Helga Westerlind Bénédicte Delcoigne Liselotte Tidblad Comorbidities and treatment patterns in early rheumatoid arthritis: a nationwide Swedish study RMD Open |
| title | Comorbidities and treatment patterns in early rheumatoid arthritis: a nationwide Swedish study |
| title_full | Comorbidities and treatment patterns in early rheumatoid arthritis: a nationwide Swedish study |
| title_fullStr | Comorbidities and treatment patterns in early rheumatoid arthritis: a nationwide Swedish study |
| title_full_unstemmed | Comorbidities and treatment patterns in early rheumatoid arthritis: a nationwide Swedish study |
| title_short | Comorbidities and treatment patterns in early rheumatoid arthritis: a nationwide Swedish study |
| title_sort | comorbidities and treatment patterns in early rheumatoid arthritis a nationwide swedish study |
| url | https://rmdopen.bmj.com/content/8/2/e002700.full |
| work_keys_str_mv | AT johanaskling comorbiditiesandtreatmentpatternsinearlyrheumatoidarthritisanationwideswedishstudy AT saedissaevarsdottir comorbiditiesandtreatmentpatternsinearlyrheumatoidarthritisanationwideswedishstudy AT helgawesterlind comorbiditiesandtreatmentpatternsinearlyrheumatoidarthritisanationwideswedishstudy AT benedictedelcoigne comorbiditiesandtreatmentpatternsinearlyrheumatoidarthritisanationwideswedishstudy AT liselottetidblad comorbiditiesandtreatmentpatternsinearlyrheumatoidarthritisanationwideswedishstudy |