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A study of baseline prevalence and cumulative incidence of co-morbidity and extra-articular manifestations in RA and their impact on outcome

Research output: Contribution to journalArticlepeer-review

Sam Norton, Gouri Koduri, Elena Nikiphorou, Josh Dixey, Peter Williams, Adam Young

Original languageEnglish
Pages (from-to)99-110
Number of pages12
JournalRheumatology (Oxford, England)
Issue number1
Early online date19 Oct 2012
E-pub ahead of print19 Oct 2012
PublishedOct 2012

King's Authors


Objectives. To study the prevalence at diagnosis and cumulative incidence of co-morbidity in RA, associations with clinical features and impact on outcome.

Methods. Standard clinical, laboratory and radiological measures of RA, and details of co-morbidity and extra-articular features were recorded at baseline and yearly in an inception cohort of 1460 patients with recently diagnosed RA from nine regions in the UK. The General Practice Research Database was used to compare the incidence of common co-morbid conditions (International Classification for Disease-10 codes).

Results. Baseline prevalence was 31.6% and 8.6% for all co-morbidities and extra-articular features, respectively, and 15-year cumulative incidence was 81% and 53%, respectively. Rates of hypertension [standardized incidence ratio (SIR) = 1.61; 95% CI 1.43, 1.79] and ischaemic heart disease (SIR = 1.60; 95% CI 1.35, 1.84) were raised compared with figures for the general population, as was stroke in females (SIR = 1.34; 95% CI 1.02, 1.77) and chronic obstructive pulmonary disorder in males (SIR = 1.63; 95% CI 1.17, 2.26). Co-morbidity was associated with risk of both all-cause and cardiovascular mortality (hazard ratio = 1.09; 95% CI 1.02, 1.17) and increased rates of functional decline over 10 years (b = 0.011; 95% CI 0.004, 0.019). Co-morbidity was not related to disease activity or structural damage.

Conclusion. Significant co-morbidity was present at the outset of RA, increasing with follow-up, mainly in cardiovascular, non-cardiac vascular and respiratory systems. Specific conditions (e.g. hypertension) occurred more frequently than in the general population. Co-morbidity was related to mortality and functional decline, and more intensive therapies may need consideration in these patients. As many co-existent conditions are amenable to preventative/therapeutic measures, co-morbidity needs earlier detection and management in order to reduce its impact on outcome in RA.

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