ACR 2019


Conference summaries

Epidemiology and Public Health

The Burden of Comorbidity in Patients with RA, PsA or SPA in a General Practice Registry

Presented by: Diederik De Cock, PhD
KU Leuven, Leuven, Belgium
  • In general practice, prescribers should be aware of the high burden of cardiovascular diseases and depression along with the relatively high use of opioid-based medications in patients with RA and PsA.

Rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondylarthritis (SPA) are the most common inflammatory rheumatic diseases, and associated with a high burden of comorbidities and polypharmacy, especially analgesics. [1]

  • Compare comorbidity burden and usage of pain-related medication in patients with RA, PsA and SPA versus controls in a general practitioner (GP) setting.

Type of study, patients, and inclusion criteria

  • Data were obtained from Intego, a Flemish GP-based morbidity registration network that covers 2% of the Flemish general population from 1999-2012.
  • Codes on the International Classification of Primary Care (iCPC) were selected:
    • L188 (rheumatoid/seropositive arthritis)
    • L199 (musculoskeletal disease other)
    • The ICPC codes were verified for RA/SPA/PsA diagnosis by rheumatologists.
  • Control selection was 4 controls per case, matched by age, gender, GP practice, and date of diagnosis.


  • Outcomes were based on:
    1. 3-year comorbidity incidence rates using the Rheumatic Disease Comorbidity Index (RDCI) score to map comorbidities;
    2. prevalent use of analgesic medication.
  • Over the 13-year period, 738, 229, and 167 patients were included with a diagnosis of RA, SPA, and PsA, respectively.
  • Mean RDCI at baseline was 1.2, 0.6, and 1.0 for RA, SPA or PsA respectively.
  • After 3 years, the mean RDCI was 1.5, 0.8, and 1.3 for RA, SPA, and PsA respectively.
  • The RDCI differed after 3 years between RA and controls (1.5 vs. 1.4, p=0.008), and PsA and controls (1.3 vs. 1.0), p=0.009).
  • In RA, at baseline 58% of individuals had an RDCI score ≥1 (vs. 53% of controls, p=0.01) and after 3 years, 66% of individuals had an RDCI score ≥1 (vs. 60% of controls, p=0.004).
  • In SPA, at baseline 36% of individuals had an RDCI score ≥1 (vs. 34% of controls, p=0.6) and after 3 years, 45% of individuals had an RDCI score ≥1 (vs. 41% of controls, p=0.4).
  • In PsA, at baseline 52% of individuals had an RDCI score ≥1 (vs. of 42% controls, p=0.03) and after 3 years, 60% of individuals had an RDCI score ≥1 (vs. 48% controls, p=0.003).
  • All analgesics were statistically significantly prescribed more in patients with a musculoskeletal disease compared to controls (Table).
  • This study highlights the issue of multimorbidity in patients with musculoskeletal diseases, especially for those with RA and PsA.
  • The high cardiovascular burden is substantial in these two populations.
  • The high prevalence of opioid and tramadol use in about 20% of patients with an inflammatory rheumatic disease deserves to be noted.

Key messages/Clinical perspectives

  • Patients with RA and PsA have a high burden of high cardiovascular and relatively high use of opioid-based medications.



  1. Mease PJ, Liu M, Rebello S, et al. Comparative disease burden in patients with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis: data from two Corrona registries. Rheumatol Ther. 2019 Sep 16. doi: 10.1007/s40744-019-00172-9.

Presenter disclosure: The presenter has reported that no relationships exist relevant to the contents of this presentation.

Written by: Patrick Moore, PhD

Reviewed by: Alessia Alunno, MD, PhD

Local reviewers: Alessia Alunno, MD, PhD (Italian); Aurélie Najm, MD (French); Yukinori Okada, MD, PhD (Japanese); Fabian Proft, MD (German); Javier Rodríguez-Carrio, MD, PhD (Spanish); Priscilla Wong, MD (Chinese)

Scientific Editor:  Leonard H. Calabrese, DO


A Comparative Analysis of Upadacitinib Monotherapy and Upadacitinib Combination Therapy for the Treatment of Rheumatoid Arthritis from Two Phase 3 Trials

Presented by: Maya H. Buch, MD, PhD - University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom

Rheumatoid Arthritis Treatment with Filgotinib: Week 156 Safety and Efficacy Data from a Phase 2b Open-Label Extension Study

Presented by: Arthur Kavanaugh, MD - University of California, San Diego School of Medicine, La Jolla, CA, USA


A Phase 1b/2a Trial of Tofacitinib, an Oral Janus Kinase Inhibitor, in Systemic Lupus Erythematosus

Presented by: Sarfaraz Hasni, MD - National Institute of Arthritis, Musculoskeletal, and Skin diseases/ National Institutes of Health, Bethesda, MD, USA

A Phase 3 Randomized Controlled Trial of Anifrolumab in Patients with Moderate to Severe Systemic Lupus Erythematosus

Presented by: Richard A. Furie, MD - Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA


The Burden of Comorbidity in Patients with RA, PsA or SPA in a General Practice Registry

Presented by: Diederik De Cock, PhD - KU Leuven, Leuven, Belgium



Ixekizumab Demonstrates Improvement Comparable to Adalimumab Across ACR Components in Biologic-Naïve Patients with Psoriatic Arthritis

Presented by: M. Elaine Husni, MD, MPH - Dept. of Rheumatologic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA

Tildrakizumab Efficacy on Psoriasis in Patients with Psoriatic Arthritis—An Analysis from a Phase 2 Study

Presented by: Alan M. Mendelsohn, MD - Sun Pharmaceutical Industries, Inc., Princeton, NJ, USA, Princeton, NJ, USA

Development of a Set of ASAS Quality Standards for Adults with Axial Spondyloarthritis

Presented by: Uta Kiltz, MD - Rheumazentrum Ruhrgebiet/Ruhr University Bochum, Herne, Germany

Ixekizumab in Non-Radiographic Axial Spondyloarthritis: Primary Results from a Phase 3 Trial

Presented by: Atul Deodhar, MD, MRCP - Oregon Health & Science University, Portland, OR, USA


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