Multimorbidity and Adverse Outcomes in Rheumatoid Arthritis

Sarfaroj Khan 


December 03, 2020


  • Multiple long-term conditions (LTCs) were common in patients with rheumatoid arthritis (RA).

  • Patients with RA and other LTCs, particularly comorbid osteoporosis, were at an increased risk of all-cause mortality and major adverse cardiovascular events (MACE).

Why this matters

  • Future clinical guidelines for RA should acknowledge the importance of multimorbidity when considering management planning and patient outcomes.

Study design

  • This population-based study used data from the UK Biobank to evaluate the effect of multimorbidity and a wide range of comorbid LTCs (n=42) on all-cause mortality and MACE in patients with RA (n=5658).

  • Funding: Versus Arthritis.

Key results

  • Overall, 75.7% of patients with RA had multimorbidity (34.5% of participants had 2-3 LTCs and 11.1% had ≥4 LTCs).

  • The risk of all-cause mortality was increased in patients with RA and additional LTC:

    • RA and 1 LTC (adjusted HR [aHR], 1.44; 95% CI, 1.14-1.81);

    • RA and 2-3 LTCs (aHR, 2.48; 95% CI, 2.12-2.90); and

    • RA and ≥4 LTCs (aHR, 3.30; 95% CI, 2.61-4.16).

  • Similarly, the risk of MACE was increased with:

    • RA and 1 LTC (aHR, 1.68; 95% CI, 1.31-2.15);

    • RA and 2-3 LTCs (aHR, 2.09; 95% CI, 1.73-2.54); and

    • RA and ≥4 LTCs (aHR, 3.39; 95% CI, 2.61-4.40).

  • Of the comorbid LTCs studied, osteoporosis was most strongly associated with adverse outcomes in patients with RA:

    • all-cause mortality (aHR, 2.20; 95% CI, 1.55-3.12); and

    • MACE (aHR, 3.17; 95% CI, 2.17-4.64).


  • Data on RA and LTCs were self-reported.

  • Lack of information on RA disease severity.


McQueenie R, Nicholl BI, Jani BD, Canning J, Macdonald S, McCowan C, Neary J, Browne S, Mair FS, Siebert S. Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants. BMJ Open. 2020;10(11):e038829. doi: 10.1136/bmjopen-2020-038829. PMID: 33234629 View abstract

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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