Оценка мультиморбидного профиля (CIRS) при ревматоидном артрите. Первые результаты

Objective : to assess the presence and nature of multimorbidity in patients with rheumatoid arthritis (RA) and the impact of multimorbidity on disease activity. Patients and methods . The investigation enrolled 117 patients (mean age, 54.8+14.8years) with RA according to the 2010 ACR/EULAR criteria, who had been examined and treated at the V.A. Nasonova Research Institute of Rheumatology in 2018—2019. The median disease duration was 5.0 [1.5; 9.5] years; the mean DAS28 score was 5.0+1.3. Documentation and anamnesis data were analyzed with emphasis on associated diseases. The Cumulative Illness Rating Scale (CIRS) was used to assess the profile of multimorbidity. Results and discussion . The patients with RA had a high index of the spectrum of multimorbidity; comorbidity was detected in 96 (82%) cases. The median number of diseases in one patient was 2 [1; 4], the mean total CIRS score was 6.7+3.3; the median value was 2.5 [1; 6]. The number of comorbidities diagnosed before using the CIRS was significantly fewer (by 48%; p<0.01) than was found in the investigation conducted. Chronic kidney disease that occurred in almost half (42.5%) of cases was most commonly undiagnosed in the cohort under study; on average, every three patients were not found to have signs of metabolic syndrome (hyperglycemia in 29% and obesity in 13.5%) and chronic hypoxia (new-onset anemia verified in 24% of cases). There was a correlation of the quantitative equivalent of multimorbidity with the clinical and laboratory measures of RA activity, including the number of painful joints (r = 0.39; p<0.001), overall patient assessment (r=0.37; p=0.03), physician's global assessment of disease activity (r = 0.37; p < 0.01), DAS28 (r = 0.42; p<0.001), CDAI (r=0.37; p<0.001), SDAI (r=0.34; p< 0.001), HAQ (r=0.34;p<0.001). The total CIRSscore did not differ in patients with early- and advanced- or end-stage RA: 6.6+3.5 and 6.7+3.3, respectively (p=0.9). Conclusion . A systematic screening of multimorbidity should be carried out in all patients with RA. It is advisable to use the CIRS to estimate the prevalence of multimorbidity and its consequences.