Beyond Heart Disease in Rheumatoid Arthritis: Multimorbidity

项目总结/摘要 类风湿性关节炎（RA）患者继续经历30-40%的额外死亡风险，尽管进展 在过去的二十年里，在之前的资助年度，我们确定了心血管疾病 (CV)疾病是RA死亡的主要原因，RA患者的CV疾病增加了1.5-2倍 与一般人群相比。我们和其他人已经表明，RA患者的CV死亡率过高， 最近下降，但RA的总体超额死亡率没有改善。我们假设，努力改善 通过减少CV死亡来降低RA的总生存率失败，因为RA的全身性炎症影响 多个身体系统，并且大多数患者表现出涉及多个， 相互关联的慢性健康状况（多发病）。近年来，RA患者中 多发病率和每例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，RA疾病活动，RA治疗，生活方式之间的复杂相互关系， 其他危险因素及其对RA患者结局的影响。本项目的目标是：（1） 确定类风湿关节炎患者与非类风湿关节炎患者之间的多变量聚类;（2） 确定多因素对长期结果的影响;（3）制定和验证风险评分， 类风湿关节炎的常见病这些目标将利用罗切斯特流行病学项目来实现， 扩展（至n= 2，295）并扩展现有的基于人群的RA患者队列，并使用队列 OptumLabs数据仓库中的RA患者（n> 50，000）。将确定多个群集 适用于不同年龄、性别、种族/民族和美国地理区域的RA患者。纵向 将确定多发病轨迹，并将其对RA患者结局的影响 与没有RA的人相比。多因素对死亡率、身体功能 （由20年来收集的年度评估确定），保健利用（门诊， 住院，急诊室就诊和预防服务），以及RA缓解的实现也将 被确定。将为心血管疾病、间质性肺疾病和肺结核制定新的发病风险评分。 疾病和胃肠道出血/穿孔。这些和现有的骨折评分， 严重感染将使用OptumLabs数据仓库进行外部验证。这些信息将 确定如何识别RA患者，以最大的风险，积累多Mortoform，以及如何 多发性骨髓瘤导致类风湿关节炎患者预后不良。我们的发现也将刺激 制定预防性战略以延迟多发性硬化症的发作（例如，防止严重 感染），这将减缓与身体功能的多发病和年龄相关的下降的进展 并最终延长类风湿关节炎患者的寿命。

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.