Assessing the multimorbid profile (CIRS) in rheumatoid arthritis. First results

Objective: to assess the presence and nature of multimorbidity in patients with rheumatoid arthritis (RA) and the impact of multimorbidity on disease activity.

Patients and methods. The investigation enrolled 117 patients (mean age, 54.8+14.8years) with RA according to the 2010 ACR/EULAR criteria, who had been examined and treated at the V.A. Nasonova Research Institute of Rheumatology in 2018—2019. The median disease duration was 5.0 [1.5; 9.5] years; the mean DAS28 score was 5.0+1.3. Documentation and anamnesis data were analyzed with emphasis on associated diseases. The Cumulative Illness Rating Scale (CIRS) was used to assess the profile of multimorbidity.

Results and discussion. The patients with RA had a high index of the spectrum of multimorbidity; comorbidity was detected in 96 (82%) cases. The median number of diseases in one patient was 2 [1; 4], the mean total CIRS score was 6.7+3.3; the median value was 2.5 [1; 6]. The number of comorbidities diagnosed before using the CIRS was significantly fewer (by 48%; p<0.01) than was found in the investigation conducted. Chronic kidney disease that occurred in almost half (42.5%) of cases was most commonly undiagnosed in the cohort under study; on average, every three patients were not found to have signs of metabolic syndrome (hyperglycemia in 29% and obesity in 13.5%) and chronic hypoxia (new-onset anemia verified in 24% of cases). There was a correlation of the quantitative equivalent of multimorbidity with the clinical and laboratory measures of RA activity, including the number of painful joints (r = 0.39; p<0.001), overall patient assessment (r=0.37; p=0.03),physician's global assessment of disease activity (r = 0.37; p < 0.01), DAS28 (r = 0.42; p<0.001), CDAI (r=0.37; p<0.001), SDAI (r=0.34; p< 0.001), HAQ (r=0.34;p<0.001). The total CIRSscore did not differ in patients with early- and advanced- or end-stage RA: 6.6+3.5 and 6.7+3.3, respectively (p=0.9).

Conclusion. A systematic screening of multimorbidity should be carried out in all patients with RA. It is advisable to use the CIRS to estimate the prevalence of multimorbidity and its consequences.

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