Chronic Conditions and Health Problems in Rheumatic Diseases: Comparisons with Rheumatoid Arthritis, Noninflammatory Rheumatic Disorders, Systemic Lupus Erythematosus, and Fibromyalgia

• Published in: Journal of rheumatology 2010-02, Vol.37 (2), p.305-315
• Main Authors: WOLFE, Frederick, MICHAUD, Kaleb, LI, Tracy, KATZ, Robert S
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Biological and medical sciences; Cardiovascular Diseases - epidemiology; Comorbidity; Databases, Factual; Diseases of the osteoarticular system; Female; Health Status; Health Surveys; Humans; Inflammatory joint diseases; Lupus Erythematosus, Systemic - epidemiology; Male; Medical sciences; Mental Disorders - epidemiology; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Prevalence; Quality of Life; Rheumatic Diseases - epidemiology; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Surveys and Questionnaires
• ISSN: 0315-162X; 1499-2752
• DOI: 10.3899/jrheum.090781

Objectives. 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.