To determine whether multimorbidity is associated with treatment changes and achieving target disease activity thresholds in patients with active rheumatoid arthritis (RA).
We conducted a retrospective cohort study of adults with active RA within the Rheumatology Informatics System for Effectiveness (RISE) registry. Multimorbidity was measured using RxRisk, a medication-based index of chronic disease. We used multivariable logistic regression models to assess the associations of multimorbidity with the odds of initiating a new DMARD in active RA and, among those initiating a new DMARD, the odds of achieving low disease activity or remission.
We identified 15,626 (RAPID3 cohort) and 5,733 (CDAI cohort) patients with active RA, of which 1,558 (RAPID3) and 834 (CDAI) initiated a new DMARD and had follow-up disease activity measures. Patients were middle aged, female and Caucasian predominant, and on average received medications from 6-7 RxRisk categories. Multimorbidity was not associated with new DMARD initiation in active RA. However, a greater burden of multimorbidity was associated with lower odds of achieving treatment targets (per 1-unit RxRisk OR 0.95 [95% CI 0.91-0.98] RAPID3 cohort; OR 0.94 [95% CI 0.90-0.99] CDAI cohort). Those with the highest burden of multimorbidity had the lowest odds of achieving target RA disease activity (OR 0.54 [0.34-0.85] RAPID3 cohort; OR 0.65 [0.37-1.15] CDAI cohort).
These findings from a large, real-world registry illustrate the potential impact of multimorbidity on treatment response and indicate that a more holistic management approach targeting multimorbidity may be needed to optimize RA disease control in these patients.