Frequency and Predictors of Communication About High Blood Pressure in Rheumatoid Arthritis Visits

IntroductionClinical registries are a potentially valuable resource to study the effects of medical interventions on outcomes, particularly patient-reported outcomes like health-related quality of life, which are not included in administrative data. However, because clinical registries are primarily intended for patient management and not for research, their validity must be established. Objectives and ApproachOur objective was to validate patient self-reported health conditions in a clinical registry. Study data were from a population-based regional joint replacement registry in the Canadian province of Manitoba. The clinical registry data were linked to administrative health data. Validated administrative data algorithms for 12 conditions were defined using diagnosis codes in hospital and physician records and medication codes in prescription drug records for the period up to three years prior to the joint replacement surgery. Accuracy of the clinical registry data was estimated using Cohen’s kappa coefficient, sensitivity, specificity, and positive and negative predictive values (PPV; NPV); 95% confidence intervals were also estimated. Analyses were stratified by joint type, age group, and sex. ResultsThe study cohort included 20,592 individuals (average age 66.3 years; 58.4% female); 8,424 (40.9%) had a total hip replacement. Sensitivity of the clinical registry data ranged from 16% (anemia) to more than 70% (diabetes, high blood pressure, rheumatoid arthritis); specificity was greater than 92% for all conditions, except back pain and high blood pressure. PPV ranged from 19% (back pain) to 83% (diabetes). Chance-adjusted agreement was very good for diabetes (kappa: 0.74), moderate for heart disease and high blood pressure (kappa range: 0.41-0.53) and poor or fair for back pain, anemia, cancer, depression, kidney disease, liver disease, rheumatoid arthritis and stomach ulcers (kappa range: 0.14-0.37). Estimates varied by sex (i.e., generally higher agreement for females) and age (i.e., generally lower agreement for older age groups), but not joint type. Conclusion/ImplicationsSelf-reported health conditions in registry data had good validity for conditions with clear diagnostic criteria, but low validity for conditions that are difficult to diagnose or rare (e.g., cancer). Linked registry and administrative data is strongly recommended to ensure valid and accurate comorbidity measures when developiong risk prediction models and conducting inter-jurisdictional comparisons of patient-reported outcome measures.

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Comparison of Drug Use Between Clinical Practice and Regulatory Approval: Results in Older Japanese Patients With Rheumatoid Arthritis, Diabetes, High Blood Pressure, or Depression

Therapeutic Innovation & Regulatory Science ◽

10.1177/2168479016648731 ◽

2016 ◽

Vol 50 (6) ◽

pp. 743-750 ◽

Cited By ~ 1

Author(s):

Nanae Tanemura ◽

Yoshiaki Uyama ◽

Kengo Nagashima ◽

Takahiro Suzuki ◽

Yasuko Asahina ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Blood Pressure ◽

Clinical Practice ◽

Drug Use ◽

High Blood Pressure ◽

Japanese Patients ◽

Regulatory Approval

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AB0261 IMPACT OF COMORBIDITIES IN THE DISEASE ACTIVITY OF PATIENTS WITH SPONDYLOARTHRITIS AND RHEUMATOID ARTHRITIS: TUNISIAN REGISTRY (BINAR)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3738 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1429.2-1430

Author(s):

R. Tekaya ◽

L. Rouached ◽

A. Ben Tekaya ◽

O. Saidane ◽

S. Bouden ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

High Blood Pressure ◽

Disease Activity Score ◽

Activity Level ◽

Activity Score ◽

Gastrointestinal Ulcer

Background:Comorbidities can be associated with rheumatoid arthritis (RA) and spondyloarthritis (SpA). This association can be fortuitous but can also be secondary to rheumatism itself or to the effects of the treatments used. These comorbidities can worsen the disease and even increase patient mortality.Objectives:To assess the prevalence of comorbidities in RA or SpA patients from the Tunisian BIologics National Registry (BINAR) and to focus on their influence on the disease activity.Methods:BINAR is a multicenter non-interventional and prospective study, conducted in Tunisia with 80 rheumatologists over a period of three years. It included patients with RA (ACR / EULAR 2010 criteria) or SpA (ASAS 2009 criteria). Data were collected and analyzed through an electronic platform managed by DACIMA. They included demographic data, smoking status and types of comorbidities (cardiovascular disease, diabetes, dyslipidemia, osteoporosis, high blood pressure (HBP), neoplasia, gastrointestinal ulcer, depression and fibromyalgia). RA activity was evaluated by the DAS28-VS score and SpA activity by the BASDAI and ASDAS-CRP scores.Results:We included 298 patients (175 PR and 123 SpA) making the mean sex ratio 0.6 and mean age 49.18 years ± 14.1 [18-79]. Mean BMI was 27.0 ± 5.5 kg / m2[15 -45] and 17.7% of the patients were current smokers. Concerning disease activity, mean DAS28-VS in RA was at 4.9 ± 1.5 [1.1 - 8.1 and mean BASDAI and ASDAS-CRP, in SpA, were respectively 4.1 ± 1.8 and 2.8 ± 1.1. Comorbidities were noted in 54% of patients (62.1% in SpA and 37.9% in RA), with an average of 1.7 comorbidities per patient.The most common comorbidities were osteoporosis (38.8%), cardiovascular disease (20.1%), diabetes (16.8%), HBP (18.1%), dyslipidemia (6.7%) and GIU (6.0%). Depression, fibromyalgia and neoplasia were mentioned in 1.7%, 1% and 1%, respectively.No correlation was found between the number of comorbidities and the activity level of RA: DAS28-VS (p=0.12), nor the activity level of SpA: BASDAI(p=0.07), ASDAS-CRP(p=0.15). Correlations were studied between each comorbidity and activity disease parameters of RA and SpA, they are specified in Table 1. We found that only the presence of osteoporosis was associated with SpA activity, (ASDAS-CRP; p = 0.02).Tableau n°1:Relation between comorbidities and the disease activity parameters of rheumatoid arthritis and SpondyloarthritisDAS 28 ESRBASDAIASDAS CRPDiabetesp = 0.737p = 0.633p = 0.652High Blood pressurep = 0.252p = 0.998p = 0.323Obesityp = 0.565p = 0.585p = 0.904Dyslipidemiap = 0.332p = 0.349p = 0.997Osteoporosisp = 0.372p = 0.989p = 0.020Gastrointestinal ulcerp = 0.829p = 0.286p = 0.910DAS: disease activity score; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; ASDAS: Ankylosing Spondylitis Disease Activity ScoreConclusion:According to this study, in patients with RA and SpA associated comorbidities may occur more frequently than expected (54%). However, they had no relation to the activity of the disease according to their frequencies or their types, except osteoporosis which was significantly associated with the SpA activity. Identifying these comorbidities may affect the management and treatment decisions for these patients to ensure an optimal clinical outcome.Acknowledgments:noneDisclosure of Interests:None declared

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AB0293 FACTORS ASSOCIATED WITH INITIATION OF BIOLOGIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS IN MOROCCAN PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5633 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1445.3-1445

Author(s):

O. Hammou ◽

F. Chennouf ◽

H. Azzouzi ◽

I. Linda

Keyword(s):

Rheumatoid Arthritis ◽

Blood Pressure ◽

High Blood Pressure ◽

Biologic Agents ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Biologic Dmards ◽

Factors Associated ◽

History Of ◽

Disease Modifying

Background:Rheumatoid arthritis (RA) is a progressive autoimmune disorder of joints that is associated with high health care costs, yet guidance is lacking on how early to initiate biologic disease-modifying antirheumatic drugs (DMARDs). Few studies have examined the factors associated with the transition from non biologic DMARDs to biologic DMARDs in RA patients.Objectives:to examine the association of patient’s comorbidities with initiation of biologic DMARDs (disease-modifying antirheumatic drugs) in rheumatoid arthritis (RA).Methods:cross-sectional study was designed on a cohort of RA patients. Sociodemographic, clinical data and comorbidities were collected. Logistic regression analysis was used to explore the impact of comorbidities on the initiation of bDMARD. The statistical analysis was done by SPSS. 20, p <0.05 was considered significant.Results:among the 257 patients, 90.5% were females. Their mean age was 54.66 ± 11.9 years. The most frequent comorbidities in our population were: high blood pressure (22.5%), diabetes (16.6%), history of heart disease (5.1%), history of neoplasia (2.4%) and nephropathies (2%). RA patients with comorbidities were more likely to initiate bDMARD: high blood pressure (p = 0.003 OR=2.36, 95% CI: 1.332- 4.181), history of heart disease (p = 0.036 OR=3.01, 95% IC: 1.073-8.468) and history of neoplasia (p = 0.026 OR= 5.07, 95% CI: 1.219- 21.110). In multiple regression models, high blood pressure was associated to the initiation of biologic agents (p= 0.026, OR= 2.07, 95% CI: 1.090-3.932).Conclusion:the probability of initiating therapy with biologic agents in patients with RA is affected by different co-morbidities in our context specifically hypertension.References:[1]Machado-Alba JE, et al. Time to and factors associated with initiation of biological therapy in patients with rheumatoid arthritis in Colombia. Rev Colomb Reumatol. 2018[2]Priyanka Gaitonde et al. Factors associated with use of disease modifying agents for rheumatoid arthritis in the National Hospital and Ambulatory Medical Care Survey. Seminars in Arthritis and Rheumatism. 2017Disclosure of Interests:None declared

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AB1296-HPR PREVALENCE OF COMORBIDITIES IN A COHORT OF PATIENTS IN AN EDUCATIONAL MULTIDISCIPLINARY PROGRAM

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5024 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1938-1939

Author(s):

M. Cabrera ◽

F. Rodriguez ◽

D. Buitrago-Garcia ◽

G. Sánchez ◽

P. Santos-Moreno

Keyword(s):

Rheumatoid Arthritis ◽

Blood Pressure ◽

Disease Activity ◽

High Blood Pressure ◽

Complex Disease ◽

Categorical Variables ◽

Life Styles ◽

Multidisciplinary Program ◽

Conventional Dmards ◽

High Prevalence

Background:Rheumatoid arthritis (RA) is a chronic inflammatory and complex disease. Patients with RA face other diseases that might lead to increase morbidity. In patients with RA it has been stablished a high prevalence of comorbidities and their risk factors (1).Objectives:The aim of this study was to evaluate the prevalence of comorbidities in Colombian patients with RA enrolled in an educational multidisciplinary program and possible correlation with disease activityMethods:We performed a cross-sectional study; we included patients with confirmed diagnosis of rheumatoid arthritis in a specialized RA center. We collected sociodemographic data, and markers of disease activity DAS28. We collected data regarding the history of comorbidities such as hypertension, dyslipidemia, osteoporosis, type 2 diabetes mellitus, hypothyroidism, malignancies, among others. We performed a descriptive analysis, variables with a normal distribution were described using mean and standard deviation (SD), and non- normal distributed variables were described using median and interquartile range. Categorical variables were presented as rates. We evaluated the relationship between disease activity and comorbidities.Results:We included 251 patients; mean age was 59 ± 9.8 years old, with a high proportion of women 93%; median disease duration was 15 years RIQ (8-20); in this study, 145 (65%) of patients were in remission; 35 (11%) had low, 44 (20%) moderate and 10 (4%) high disease activity. Regarding pharmacological therapy, 55% were receiving conventional DMARDs. The prevalence of comorbidities was 85%, the most common were high blood pressure 25% followed by hypothyroidism 12% and diabetes 10%, 0.7% of patients had malignancies such as thyroid cancer or breast cancer, 1.29% of patients had renal comorbidities. Among comorbidities related to RA 30% had osteoporosis and 20% arthrosis. We did not find a statistical association between DAS28 and comorbidities.Conclusion:As other studies have shown, there is a high prevalence of comorbidities among RA patients, mainly high blood pressure. Due to the above, it is relevant to evaluate the risks factors of patients with RA, especially cardiovascular risks. We consider that a multidisciplinary program represents an opportunity not only to educate patients about healthy life styles and the management of RA, but also other diseases in order to increase the empowering of the health status in these poly pathological patients(2).References:[1]Gullick NJ, Scott DL. Co-morbidities in established rheumatoid arthritis. Best practice & research Clinical rheumatology. 2011;25(4):469-83.[2]Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, Cardenas-de la Garza JA, Vera-Pineda R, Wah-Suarez M, et al. Prevalence of comorbidities in Mexican mestizo patients with rheumatoid arthritis. Rheumatology international. 2017;37(9):1507-11.Acknowledgments:This project has been funded by a collaboration between the Ministry of Science, Technology and Innovation COLCIENCIAS (contract 746-2018), the Fundación Universitaria de Ciencias de la Salud and Biomab - Center for Rheumatoid ArthrtitisDisclosure of Interests:Michael Cabrera: None declared, Fernando Rodriguez: None declared, Diana Buitrago-Garcia: None declared, GUILLERMO SÁNCHEZ: None declared, Pedro Santos-Moreno Grant/research support from: I have received research grants from Abbvie, Biopas-UCB, Janssen, Novartis, Pfizer., Speakers bureau: I have been a speaker for Abbvie, Biopas-UCB, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi.

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