RESEARCH - Chronic conditions and health problems in rheumatic disease: comparisons with RA, SLE, FM, and NIRD

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J Rheumatol. 2010 Jan 15.

Chronic Conditions and Health Problems in Rheumatic Diseases:

Comparisons with Rheumatoid Arthritis, Noninflammatory Rheumatic

Disorders, Systemic Lupus Erythematosus, and Fibromyalgia.

Wolfe F, Michaud K, Li T, Katz RS.

From the National Data Bank for Rheumatic Diseases and the University

of Kansas School of Medicine, Wichita, Kansas; the University of

Nebraska Medical Center , Omaha, Nebraska; Global Outcomes Research,

Bristol-Myers-Squibb, Princeton, New Jersey; and the Rush University

Medical Center , Chicago, Illinois, USA.

OBJECTIVE: To describe and compare the prevalence of lifetime and

current self-reported comorbidity and associated quality of life in 4

rheumatic diseases, and to investigate comorbid conditions in light of

the overlap between the index condition and comorbid conditions (CC),

and in the context of symptom-type diagnoses. METHODS: We studied

comorbidity in 11,704 patients with fibromyalgia (FM), systemic lupus

erythematosus (SLE), rheumatoid arthritis (RA), and noninflammatory

rheumatic disorders (NIRD). Patients completed semiannual self-reports

relating to 22 present and past illnesses and completed the EuroQol

(EQ-5D) utility index.

RESULTS: CC were most common in FM, followed by SLE. FM comorbidity

was dominated by depression, mental illness, and symptom-type

comorbidity (e.g., gastrointestinal and genitourinary disorders). In

SLE, there were substantial increases in hypertension, depression,

cataract, fractures, and cardiovascular and cerebrovascular,

neurologic, lung, gall bladder and endocrine disorders compared with

RA. Any current CC reduced the EQ-5D utility by 0.08 to 0.16 units.

The lowest EQ-5D score was noted for current psychiatric illness

(0.55) and current depression (0.60).

CONCLUSION: Four patterns of comorbidity emerged: that associated with

aging; that associated with aging but enhanced by the index condition,

as in SLE and cardiovascular disease; comorbidity that is part of the

symptoms complex of the index condition; and CC that represent

lifetime traits or manifestations of the underlying illness.

Depression was the most strongly associated correlate of EQ-5D quality

of life, and current depression was present in about 15% of patients

with RA or NIRD and 34% to 39% of those with SLE and FM.

PMID: 20080915

http://www.ncbi.nlm.nih.gov/pubmed/20080915

Not an MD