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The influence of thyroid diseases, diabetes mellitus, primary hyperparathyroidism, vitamin B12 deficiency and other comorbid autoimmune diseases on treatment outcome in patients with rheumatoid arthritis: An exploratory cohort study.

Abstract To investigate the impact of comorbid diseases on rheumatoid arthritis (RA) outcome.All patients diagnosed with RA since 2006, who were registered in our local Danbio registry, were included in this cohort study. Patients' demographics, serology results, and Disease Activity Score in 28 joints-C-reactive protein (DAS28-CRP) at the time of diagnosis and after 4 months of treatment initiation were collected. Patients' electronic hospital records were evaluated for a positive history of thyroid diseases, diabetes mellitus, primary hyperparathyroidism, vitamin B12 deficiency, and the presence of other diagnosed autoimmune diseases.1035 RA patients were included. The observed prevalence of thyroid diseases was 11.8%, DM 10.4%, primary hyperparathyroidism 2.8%, vitamin B12 deficiency 5.8%, and other diagnosed autoimmune diseases 1.6%. There were significant associations between presence of thyroid diseases and female gender (P < .001); DM and greater age (P < .001); primary hyperparathyroidism and longer disease duration (P = .002); other diagnosed autoimmune diseases and antinuclear antibody positivity (P < .001). RA patients with thyroid diseases (P = .001) and other comorbid autoimmune diseases (P < .001) had significantly poorer initial response to the RA treatment compared to patients with isolated RA.Univariate analyses revealed that age, the presence of thyroid diseases, the presence of other diagnosed autoimmune diseases and DAS28-CRP at the time of diagnosis were significantly associated with ΔDAS28-CRP. Additionally, multivariate analysis demonstrated that ΔDAS28-CRP deterioration was significantly correlated to the presence of thyroid diseases (unstandardized regression coefficient (standard error); -0.188 (0.088), P = .030) and the presence of other diagnosed autoimmune diseases (-0.537 (0.208), P = .010).RA patients are at increased risk of specific comorbidities with possible impact on the treatment outcome. To improve this situation, periodic assessment of comorbidities should be considered.
PMID
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Thyroid disorders in patients with newly diagnosed rheumatoid arthritis is associated with poor initial treatment response evaluated by disease activity score in 28 joints-C-reactive protein (DAS28-CRP): An observational cohort study.

Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29794789
OWN - NLM
STAT- MEDLINE
DCOM- 20180604
LR  - 20180604
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 21
DP  - 2018 May
TI  - The influence of thyroid diseases, diabetes mellitus, primary
      hyperparathyroidism, vitamin B12 deficiency and other comorbid autoimmune
      diseases on treatment outcome in patients with rheumatoid arthritis: An
      exploratory cohort study.
PG  - e10865
LID - 10.1097/MD.0000000000010865 [doi]
AB  - To investigate the impact of comorbid diseases on rheumatoid arthritis (RA)
      outcome.All patients diagnosed with RA since 2006, who were registered in our
      local Danbio registry, were included in this cohort study. Patients'
      demographics, serology results, and Disease Activity Score in 28
      joints-C-reactive protein (DAS28-CRP) at the time of diagnosis and after 4 months
      of treatment initiation were collected. Patients' electronic hospital records
      were evaluated for a positive history of thyroid diseases, diabetes mellitus,
      primary hyperparathyroidism, vitamin B12 deficiency, and the presence of other
      diagnosed autoimmune diseases.1035 RA patients were included. The observed
      prevalence of thyroid diseases was 11.8%, DM 10.4%, primary hyperparathyroidism
      2.8%, vitamin B12 deficiency 5.8%, and other diagnosed autoimmune diseases 1.6%. 
      There were significant associations between presence of thyroid diseases and
      female gender (P &lt; .001); DM and greater age (P &lt; .001); primary
      hyperparathyroidism and longer disease duration (P = .002); other diagnosed
      autoimmune diseases and antinuclear antibody positivity (P &lt; .001). RA patients
      with thyroid diseases (P = .001) and other comorbid autoimmune diseases (P &lt;
      .001) had significantly poorer initial response to the RA treatment compared to
      patients with isolated RA.Univariate analyses revealed that age, the presence of 
      thyroid diseases, the presence of other diagnosed autoimmune diseases and
      DAS28-CRP at the time of diagnosis were significantly associated with
      DeltaDAS28-CRP. Additionally, multivariate analysis demonstrated that
      DeltaDAS28-CRP deterioration was significantly correlated to the presence of
      thyroid diseases (unstandardized regression coefficient (standard error); -0.188 
      (0.088), P = .030) and the presence of other diagnosed autoimmune diseases
      (-0.537 (0.208), P = .010).RA patients are at increased risk of specific
      comorbidities with possible impact on the treatment outcome. To improve this
      situation, periodic assessment of comorbidities should be considered.
FAU - Emamifar, Amir
AU  - Emamifar A
AD  - Department of Medicine, Odense University Hospital, Svendborg Hospital,
      Svendborg.
AD  - Faculty of Health Sciences, University of Southern Denmark, Odense.
FAU - Jensen Hansen, Inger Marie
AU  - Jensen Hansen IM
AD  - Faculty of Health Sciences, University of Southern Denmark, Odense.
AD  - Section of Rheumatology, Department of Medicine, Odense University Hospital,
      Svendborg Hospital, Svendborg.
AD  - Danbio, Copenhagen, Denmark.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 9007-41-4 (C-Reactive Protein)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Arthritis, Rheumatoid/blood/diagnosis/*drug therapy
MH  - Autoimmune Diseases/*complications/epidemiology
MH  - C-Reactive Protein/analysis
MH  - Comorbidity
MH  - Denmark/epidemiology
MH  - Diabetes Complications/epidemiology
MH  - Female
MH  - Humans
MH  - Hyperparathyroidism, Primary/*complications/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Prevalence
MH  - Risk Factors
MH  - Thyroid Diseases/*complications/epidemiology
MH  - Treatment Outcome
MH  - Vitamin B 12 Deficiency/*complications
EDAT- 2018/05/26 06:00
MHDA- 2018/06/05 06:00
CRDT- 2018/05/26 06:00
PHST- 2018/05/26 06:00 [entrez]
PHST- 2018/05/26 06:00 [pubmed]
PHST- 2018/06/05 06:00 [medline]
AID - 10.1097/MD.0000000000010865 [doi]
AID - 00005792-201805250-00065 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 May;97(21):e10865. doi: 10.1097/MD.0000000000010865.