Beyond Heart Disease in Rheumatoid Arthritis: Multimorbidity

项目摘要/摘要 尽管取得了进展，类风湿性关节炎(RA)患者仍有30%-40%的额外死亡风险 在过去的二十年里，他在疾病管理方面取得了很大进展。在之前的几年里，我们确定了心血管疾病 心血管疾病是类风湿性关节炎的主要死亡原因，类风湿性关节炎患者的心血管疾病增加了1.5-2倍 与普通人群相比。我们和其他人已经表明，类风湿性关节炎患者的过度心血管死亡率 最近有所下降，但类风湿关节炎的总体超额死亡率并未得到改善。我们假设改进的努力 通过减少心血管死亡来降低RA的总体存活率失败，因为RA的全身性炎症影响 多个身体系统，大多数患者表现出复杂的健康问题，涉及多个， 相互关联的慢性健康状况(多发病)。近年来，类风湿性关节炎患者中 多发病和每名患者的平均发病率都有所增加。此应用程序的目标是 确定多发病、类风湿性关节炎疾病活动性、类风湿性关节炎治疗、生活方式和 其他危险因素及其对类风湿关节炎患者预后的影响。本项目的目标是：(1) 确定类风湿性关节炎患者与类似的非类风湿性关节炎患者之间的多发病聚集性； 确定多发病对长期结果的影响；以及(3)制定和验证风险评分 类风湿性关节炎的常见疾病。这些目标将利用罗切斯特流行病学项目来实现 扩大(n=2,295)和扩大现有的基于人口的类风湿性关节炎患者队列，并利用队列 OptomLabs数据仓库中的RA患者(n&>；50,000人)。多发病集群将被确定 适用于不同年龄、性别、种族/民族和美国地理区域的类风湿关节炎患者。纵向 将确定多发病轨迹及其对类风湿关节炎患者预后的影响 与没有类风湿关节炎的相似人群相比。多发性疾病对死亡率、身体功能的影响 (由20年来收集的年度评估确定)、医疗保健利用率(门诊就诊次数、 住院、急诊室就诊和预防服务)，以及类风湿关节炎的缓解也将 要下定决心。将为心血管疾病、间质性肺制定新的发病率风险评分 疾病和胃肠道出血/穿孔。这些和现有的骨质疏松性骨折评分和 严重感染将使用OptomLabs数据仓库进行外部验证。此信息将 确定如何确定RA患者具有累积多发病的最大风险以及如何 多发病导致类风湿性关节炎患者预后不佳。我们的发现也将刺激 制定预防战略，以延缓多发病的发生(例如，预防严重的 感染)，这将减缓多发性疾病的进展和与年龄相关的身体功能下降 最终延长类风湿性关节炎患者的寿命。

PROJECT SUMMARY/ABSTRACT Patients with rheumatoid arthritis (RA) continue to experience a 30-40% excess mortality risk despite advances in disease management in the past two decades. During prior grant years, we established that cardiovascular (CV) disease is the leading cause of death in RA, and CV disease is increased 1.5-2 fold in patients with RA compared to the general population. We and others have shown that the excess CV mortality in RA has declined recently, but overall excess mortality in RA has not improved. We hypothesize that efforts to improve overall survival in RA by reducing CV death have failed because the systemic inflammation in RA affects multiple body systems, and the majority of patients exhibit complex health problems involving multiple, interrelated chronic health conditions (multimorbidity). In recent years the proportion of RA patients with multimorbidity and the mean number of morbidities per patient have increased. The goal of this application is to determine the complex interrelation between multimorbidity, RA disease activity, RA therapies, lifestyle, and other risk factors, and their impact on outcomes in patients with RA. The aims of this project are to: (1) determine multimorbidity clusters among persons with RA compared to similar persons without RA; (2) determine the impact of multimorbidity on long-term outcomes; and (3) develop and validate risk scores for common morbidities in RA. These aims will be accomplished utilizing the Rochester Epidemiology Project to expand (to n=2,295) and extend the existing population-based cohort of persons with RA, and utilizing a cohort of persons with RA (n>50,000) in the OptumLabs Data Warehouse. Multimorbidity clusters will be determined for persons with RA of different ages, sexes, races/ethnicities and geographic regions of the US. Longitudinal multimorbidity trajectories will be identified and their impact on outcomes among persons with RA will be compared to similar persons without RA. The impact of multimorbidity on mortality, physical functioning (determined by yearly assessments gathered over 20 years), healthcare utilization (outpatient visits, hospitalizations, emergency room visits and preventive services), and achievement of remission in RA will also be determined. New morbidity risk scores will be developed for cardiovascular disease, interstitial lung disease, and gastrointestinal bleeds/perforations. These and the existing scores for osteoporotic fractures and serious infections will be externally validated using the OptumLabs Data Warehouse. This information will determine how to identify persons with RA at the greatest risk for accumulating multimorbidity and how multimorbidity contributes to poor outcomes among persons with RA. Our findings will also stimulate the development of preventive strategies to delay the onset of multimorbidity (e.g., prevention of serious infections), which would slow the progression of multimorbidity and age-related declines in physical functioning and ultimately extend the lifespans of persons with RA.