The impact of comorbidities on the physical function in patients with rheumatoid arthritis

Marques, Wanessa Vieira; Cruz, Vitor Alves; Rego, Jozelia; Silva, Nilzio Antonio da

doi:10.1016/j.rbr.2015.01.009

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Revista Brasileira de Reumatologia

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Sumário

Original articles • Rev. Bras. Reumatol. 56 (1) • Jan-Feb 2016 • https://doi.org/10.1016/j.rbr.2015.01.009 copy

The impact of comorbidities on the physical function in patients with rheumatoid arthritis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

To investigate the association of comorbidities with mobility limitation and functional disability in patients with rheumatoid arthritis (RA) and to identify which comorbidity indicator is the most appropriate to determine this association.

Methods:

Sixty RA patients were enrolled in a cross-sectional study for a period of 11 months. Comorbidities were assessed using three indicators: (i) the total number of comorbidities (NCom); (ii) the Charlson comorbidity index (CCI); and (iii) the functional comorbidity index (FCI). Disease activity was assessed using the Disease Activity Score 28 (DAS-28/ESR). Functional capacity was measured using the Health Assessment Questionnaire (HAQ), and mobility was measured using Timed Up and Go Test (TUG) and Five Times Sit To Stand Test (FTSTS). Statistical analysis was performed using a stepwise log-linear multiple regression with a significance level of 5%.

Results:

In the final model, only comorbidity (FCI) was associated with mobility limitation (FTSTS and TUG). The FCI score explained 19.1% of the variability of the FTSTS (coefficient of determination [R²] = 0.191) and 19.5% of the TUG variability (R² = 0.195). With regard to functional disability (HAQ), the associated factors were comorbidity (FCI) and disease activity (DAS-28/ESR), which together explained 32.9% of the variability of the HAQ score (adjusted R² = 0.329).

Conclusion:

Comorbidities were associated with mobility limitation and functional disability in RA patients. The FCI proved to be an appropriate comorbidity indicator to determine this association.

Keywords:
Rheumatoid arthritis; Comorbidities; Physical function; Mobility

Characteristics		Values
Demographics
	Age, mean (SD) (min–max), years	59 (9.1) (43–80)
	Women, n (%)	53 (88.3%)
Self-reported race, n (%)
	Caucasian	26 (43.3%)
	African	11 (18.3%)
	Brown	23 (38.3%)
	Positive RF, n (%)	43 (71.7%)
	Disease duration, mean (SD) (min–max), years	11.5 (8.9) (0.4–30)
	History of falls, n (%)	16 (26.7%)
	Use of walking aids, n (%)	8 (13.3%)
	Smokers or former smokers, n (%)	37 (61.7%)
	Practitioners of physical activity, n (%)	10 (16.7%)

Evaluation of comorbidities
	NCom score, mean (SD) (min–max)	3.6 (2.1) (0–8)
	CCI score, mean (SD) (min–max)	0.25 (0.51) (0–2)
	FCI score, mean (SD) (min–max)	2.0 (1.5) (0–5)

Disease activity assessment
	ESR, median (IQR), mm/hour	22.5 (10.5–34.5)
	DAS-28/ESR, mean (SD) (min–max)	3.7 (1.4) (0.5–6.8)

Mobility assessment
	STS, median (IQR), seconds	12.5 (10.5–20.4)
	TUG, median (IQR), seconds	12.8 (10.9–16.3)

Assessment of functional capacity
	HAQ score, mean (SD) (min–max)	1.07 (0.76) (0–3)

Comorbidities	n
Osteoporosis	28
Arthritis (osteoarthritis) ^b b Comorbidity present in FCI.	27
Visual deficits (cataract, glaucoma, macular degeneration) ^b b Comorbidity present in FCI.	17
Obesity and/or BMI >30 kg/m²^b b Comorbidity present in FCI.	12
Upper gastrointestinal tract disease (ulcer, hernia, reflux) ^a a Comorbidity present in CCI. ^,^b b Comorbidity present in FCI.	11
Diabetes mellitus type 2 ^a a Comorbidity present in CCI. ^,^b b Comorbidity present in FCI.	9
Depression ^b b Comorbidity present in FCI.	5
Anxiety or panic syndrome ^b b Comorbidity present in FCI.	3
Auditory deficits (difficulty hearing, even with hearing aids) ^b b Comorbidity present in FCI.	3
Congestive heart failure ^a a Comorbidity present in CCI. ^,^b b Comorbidity present in FCI.	1
Peripheral vascular disease ^a a Comorbidity present in CCI. ^,^b b Comorbidity present in FCI.	1
Cerebrovascular disease ^a a Comorbidity present in CCI. ^,^b b Comorbidity present in FCI.	1
Chronic obstructive pulmonary disease ^a a Comorbidity present in CCI. ^,^b b Comorbidity present in FCI.	1
Asthma ^b a Comorbidity present in CCI.	1
Neurological disease (Parkinson's disease) ^b b Comorbidity present in FCI.	1
Connective tissue disease ^a a Comorbidity present in CCI.	0
Liver disease (mild, moderate or severe) ^a a Comorbidity present in CCI.	0
Angina ^b b Comorbidity present in FCI. /myocardial infarction ^a a Comorbidity present in CCI. ^,^b b Comorbidity present in FCI.	0
Degenerative disk disease (spinal stenosis, or severe chronic low back pain) ^b b Comorbidity present in FCI.	0
Dementia ^a a Comorbidity present in CCI.	0
Hemiplegia ^a a Comorbidity present in CCI.	0
Moderate or severe kidney disease ^a a Comorbidity present in CCI.	0
Non-metastatic solid tumor ^a a Comorbidity present in CCI.	0
Leukemia ^a a Comorbidity present in CCI.	0
Lymphoma ^a a Comorbidity present in CCI.	0
Solid metastatic tumor ^a a Comorbidity present in CCI.	0
AIDS ^a a Comorbidity present in CCI.	0

Independent variables		Dependent variables
		STS	TUG	HAQ
Age, years	R ²	0.074 ^a a Significant p ≤ 0.05.	0.063 ^a a Significant p ≤ 0.05.	0.002
Male gender	R ²	0.058 ^a a Significant p ≤ 0.05.	0.010	0.000
Positive RF	R ²	0.000	0.000	0.000
Disease duration, years	R ²	0.056 ^a a Significant p ≤ 0.05.	0.020	0.047 ^a a Significant p ≤ 0.05.
Physical activity	R ²	0.000	0.003	0.013
NCom score	R ²	0.121 ^b b Significant p ≤ 0.01.	0.144 ^b b Significant p ≤ 0.01.	0.077 ^b b Significant p ≤ 0.01.
CCI score	R ²	0.021	0.000	0.000
FCI score	R ²	0.191 ^b b Significant p ≤ 0.01.	0.195 ^b b Significant p ≤ 0.01.	0.178 ^b b Significant p ≤ 0.01.
DAS-28/ESR	R ²	0.033	0.056	0.244 ^b b Significant p ≤ 0.01.

Dependent variables	Independent variables	exp(β )	95% CI	p	Adjusted R²
STS	FCI	1.128	1.062–1.201	<0.001	0.191
TUG	FCI	1.172	1.073–1.285	0.001	0.195
HAQ	FCI	1.167	1.054–1.290	0.005	0.329
	DAS-28/ESR	1.279	1.132–1.451	<0.001

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E-mail: sbre@terra.com.br

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[1] *Corresponding author. E-mail: wanessavmarques@yahoo.com.br (W.V. Marques).