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Poor and Good Health Outcomes in Rheumatoid Arthritis: The Role of Comorbidity INES RUPP, HENDRIEK C. BOSHUIZEN, LEO D. ROORDA, HUIBERT J. DINANT, CATHARINA E. JACOBI, and GEERTRUDIS A.M. van den BOS ABSTRACT. Objective. To assess the predictive value of selected sociodemographic characteristics, rheumatoid arthritis (RA)-specific clinical factors, and comorbidity with respect to patient-reported health outcomes, i.e., pain, disability, and health-related quality of life, among patients with RA. Methods. Data were collected between 1997 and 2002 among 882 patients with RA of varying disease duration using questionnaires and clinical examinations. Health outcomes were evaluated over 5 years as a function of disease duration by means of random intercept linear regression. Then we selected the 10% of patients with the poorest and best health outcomes during the 5 years of followup compared to others with equal disease duration. Separate multivariate logistic regression analyses were conducted to identify factors associated with poor and good outcomes. Results. Sociodemographic characteristics seemed to be less important in the prediction of health outcomes. After RA-specific clinical factors, comorbidity appeared to be a major predictive factor for health outcomes. In particular, psychological comorbidity, i.e., depressive symptomatology, was a consistent predictive factor with respect to all health outcomes. Conclusion. Assessment of comorbidity needs to be incorporated into the management of RA in order to prevent poor outcomes and to adapt therapies to the specific situation of individual patients. Periodic routine screening for and monitoring of somatic and psychological comorbidity should be included in clinical practice. (First Release July 1 2006; J Rheumatol 2006;33:1488–95) Key Indexing Terms:
COMORBIDITY From the Department of Social Medicine, Academic Medical Center, University of Amsterdam, Amsterdam; National Institute of Public Health and the Environment, Bilthoven; Department of Rehabilitation Medicine, Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam; Jan van Breemen Institute, Center for Rheumatology and Rehabilitation, Amsterdam; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; and Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands. Supported by the Jan van Breemen Institute, the Dutch Arthritis Association (het Nationaal Reumafonds), and the Netherlands Organization for Health Research and Development – Medical Sciences (ZonMw; grant 940-32-002). I. Rupp, MD, PhD, Researcher; G.A.M. van den Bos, PhD, Professor of Social Medicine, Department of Social Medicine, Academic Medical Center, University of Amsterdam; H.C. Boshuizen, PhD, Statistician, National Institute of Public Health and the Environment; L.D. Roorda, MD, PT, PhD, Physiatrist, Department of Rehabilitation Medicine, Institute for Research in Extramural Medicine, VU University Medical Center Jan van Breemen Institute, Center for Rheumatology and Rehabilitation; H.J. Dinant, MD, Rheumatologist, Jan van Breemen Institute, Center for Rheumatology and Rehabilitation, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam; C.E. Jacobi, PhD, Epidemiologist, Department of Social Medicine, Academic Medical Center, University of Amsterdam, Department of Medical Decision Making, Leiden University Medical Center. Address reprint requests to Dr. I. Rupp, Department of Social Medicine, Academic Medical Center/University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands. E-mail: i.rupp@amc.uva.nl Accepted for publication March 23, 2006.
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