Age, sex and multimorbidity in RA

3 minute read

A large database study on comorbidities in rheumatoid arthritis highlights the importance of individualised care plans.

Mayo Clinic researchers investigating multimorbidity and comorbidities in rheumatoid arthritis patients have found key differences according to age and sex.

Among the findings were that women with RA have a higher prevalence of multimorbidity than men and were more likely to experience multimorbidity than women without RA.

The differences between women and men with RA were more pronounced in the younger ages (18-50), although were still significant in those aged over 50. While men had more cardiovascular conditions, women had more musculoskeletal, psychological and neurological conditions.   

Writing in Rheumatology, the authors said that, to their knowledge, “this is the first study that has evaluated how the relationship between RA and multimorbidity, along with key comorbidities, vary by sex across the lifespan using a large and representative sample”.

“These findings highlight a need for individualised treatment and supporting research and policies that account for the variation in care needs in people with RA. It is essential that research, clinical, and policy agendas for rheumatic diseases acknowledge and support the differences in care needs by sex and gender across the lifespan.”

Using data from a US administrative claims database, a total of over 150,000 people with RA were matched 1:1 with people without RA. The average age for both groups was around 60, and 76% were women.

The researchers identified comorbidities from set of 44 chronic conditions shown to be clinically relevant and prevalent in RA patients and the general population. Multimorbidity was defined as having at least two conditions from the list, and substantial multimorbidity was defined as at least five conditions.

For people with RA aged 18-50, women had a percentage point increase of 7.5 in risk of multimorbidity and a percentage point increase of 4.4 in risk of substantial multimorbidity when compared with men.

In the over 50s, women with RA had a percentage point increase of 2.1 in risk of multimorbidity and a percentage point increase of 2.5 in risk of substantial multimorbidity when compared with their male counterparts.

When compared with women, men with RA had a higher prevalence of cardiovascular conditions, including coronary artery disease, hyperlipidaemia and hypertension in both age groups, as well as cardiac arrhythmia, heart failure and valvular heart disease in the over 50s.

Women with RA, on the other hand, had an increased prevalence of psychological conditions (such as depression and anxiety), neurological (headaches, sleep issues, neuropathy) and general musculoskeletal conditions (chronic back pain and fibromyalgia) compared with men.

“Our primary finding was that sex was an independent and significant risk factor for multimorbidity in the RA population, with the strongest effect observed in people aged 18-50 years. The increased prevalence of multimorbidity in women with RA is consistent with the multimorbidity differences observed in the general population,” wrote the authors.

“Notably, sex may serve as a direct determinant, as well as a context-specific proxy for underlying social, behavioural, and environmental factors, of multimorbidity.”

The authors pointed out that women in the general population are more likely to seek healthcare than men, which may result in chronic conditions being picked up earlier in women and at more severe stages in men.

“Our study adds to the literature by confirming such disparities are even greater in the RA population.”

The authors suggested that routine screening of RA patients would help identify comorbidities that can impact on treatment decisions, and head off potential treatment inequities such as poorer adherence in women and a lower propensity to seek care in men.

The study also underscores the need for individualised care plans targeting disease and symptom management in both sexes across the lifespan.

Rheumatology 2023, online 31 August

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