RA Risk Radar

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Experts Discuss:
RA Risk Radar

  •  18-minute listen
Rheumatologists Dr. Jeffrey Curtis and Dr. Jon Giles discuss the risk of comorbidities that can occur as a consequence of uncontrolled inflammation in RA

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Dr. Jeffrey Curtis & Dr. Jon Giles • October 2024
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  • Transcript
    Dr. Jeffrey Curtis & Dr. Jon Giles • October 2024

The experts

Jeffrey R. Curtis, MD, MS, MPH

Professor of Medicine, Epidemiology, and Computer Science

Division of Clinical Immunology and Rheumatology

University of Alabama at Birmingham

Jon T. Giles, MD, MPH

Associate Professor of Medicine

Director of the Inflammatory Arthritis Center

Cedars-Sinai Medical Center in Los Angeles, California

Key information

Risk of certain comorbidities is increased in patients with uncontrolled inflammation in RA, including:

Cardiovascular disease1,2

Serious infection3

Malignancy4

In a rheumatology setting, it is particularly important to consider the consequences of uncontrolled inflammation on comorbidity risks​

Certain patient-specific factors have also been observed to increase comorbidity risk

Click to highlight the risk factors associated with each comorbidity

This triad of modifiable patient characteristics can increase patient risk across comorbidities:

Uncontrolled inflammation
Smoking
Obesity

Increased comorbidities

Increased
mortality risk

Across studies in patients with RA (treated + untreated), an increased risk of mortality related to cardiovascular disease, infection, and malignancy has been observed compared with that seen in the general public23–25

CVD23–25

aHR 1.19–1.55

Infection23,24

aHR 1.59–2.21

Malignancy23–25

aHR 1.18–1.21

Increased comorbidities

Increased
RA burden

Incidence of comorbidities adds to the overall burden of RA, including hospitalization, healthcare resource utilization, and healthcare costs26–28

Overall, mean annual total healthcare costs have been observed to be ~3-fold higher for patients with RA compared with the general population, driven in part by the increased incidence of comorbidities26

CVD27

Adjusted annual mean healthcare cost
for patients with RA and CVD: $14,145
vs patients with RA alone: $11,404

Infection28

Mean hospital charges for patients with RA hospitalized with infection*:
$35,000–$67,000

*Infections assessed: Influenza, Streptococcus pneumoniae, and 
herpes zoster.

So, what can you do for your patients with RA?

Talk to your patients about their comorbidity risks

Assess patient-specific risk regularly

Manage uncontrolled inflammation: Disease control is the goal for every patient

Want to learn more about how to assess risk in your patients?

Try these online risk calculators

Cardiovascular risk calculator:

AHA PREVENT™

Infection risk calculator:

RABBIT Risk Score of Infections

Some serious infections may be preventable: Are your patients fully vaccinated?

Click below to view the latest vaccine-related guidance from ACR for patients with rheumatic and musculoskeletal disease

Vaccination guideline

COVID-19 vaccine guidance

Knowledge Check: 
True or False

Question 1 of 5

Uncontrolled inflammation, obesity, and smoking all increase a patient with RA’s relative risk for cardiovascular disease, serious infection, and malignancy.(Required)

We value your feedback

Abbreviations
ACR, American College of Rheumatology; AHA, American Heart Association; aHR, adjusted hazard ratio; CRP, C-reactive protein; CVD, cardiovascular disease; ESR, erythrocyte sedimentation rate; IR, incidence rate; LDA, low disease activity; NSAID, nonsteroidal anti-inflammatory drug; PREVENT, predicting risk of cardiovascular disease events; RA, rheumatoid arthritis; RABBIT, Rheumatoide Arthritis: Beobachtung der Biologika-Therapie (German registry); SJC, swollen joint count; TJC, tender joint count.

References:
  1. Aviña-Zubieta JA et al. Arthritis Rheum. 2008;59(12):1690-1697.
  2. Crowson CS et al. Ann Rheum Dis. 2018;77(1):48-54.
  3. Mehta B et al. RMD Open. 2019;5(1):e000935.
  4. Beydon M et al. Lancet Reg Health Eur. 2023;35:100768.
  5. Ferguson LD et al. Rheum Dis Clin North Am. 2022;48(2):429-444.
  6. Myasoedova E et al. Ann Rheum Dis. 2016;75(3):560-565.
  7. Toussirot E. Front Med (Lausanne). 2021;8:782150.
  8. Ramírez J et al. Front Med (Lausanne). 2021;8:742713.
  9. McInnes IB, Schett G. N Engl J Med. 2011;365(23):2205-2219.
  10. Solomon DH et al. Arthritis Rheumatol. 2015;67(8):1995-2003.
  11. van Dartel SAA et al. Rheumatology (Oxford). 2013;52(6):1052-1057.
  12. Accortt NA et al. Arthritis Care Res (Hoboken). 2018;70(5):679-684.
  13. Crowson CS et al. Rheum Arthritis. 2012;64(9):2847-2855.
  14. Lauper K et al. Arthritis Care Res (Hoboken). 2018;70(12):1756-1763
  15. Nikiphorou E et al. Heart. 2020;106(20):1566-1572.
  16. Wilton KM, Matteson EL. Rheumatol Ther. 2017;4(2):333-347.
  17. Previtali E et al. Blood Transfus. 2011;9(2):120-138. 
  18. Pati S et al. Cancers (Basel). 2023;15(2):485.
  19. Huttunen R, Syrjänen J. Int J Obes (Lond). 2013;37(3):333-340.
  20. Roubille C et al. Ann Rheum Dis. 2015;74(3):480-489.
  21. Baecklund E et al. Arthritis Rheum. 2006;54(3):692-701.
  22. Subesinghe S et al. Rheumatology (Oxford). 2018;57(4):651-655.
  23. Ogdie A et al. Rheumatology (Oxford). 2017;56(6):907-911.
  24. Johnson TM et al. Arthritis Care Res (Hoboken). 2023;75(8):1648-1658.
  25. Kerola AM et al. Rheumatology (Oxford). 2022;61(12):4656-4666.
  26. Chen CI et al. Rheumatol Adv Pract. 2018;2(1):rky005.
  27. Joyce AT et al. J Rheumatol. 2009;36(4):743-752.
  28. Potera J et al. Clin Rheumatol. 2021;40(12):4845-4851.

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