UMMS Affiliation

Department of Medicine, Division of Rheumatology

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Document Type



Adult; Aged; Arthritis, Rheumatoid; Cardiovascular Diseases; Comorbidity; Cross-Sectional Studies; Female; Gastrointestinal Diseases; *Global Health; Humans; Infection; Internationality; Lung Diseases; Male; Mental Disorders; Middle Aged; Neoplasms; Osteoporosis; Prevalence; Risk Factors; Severity of Illness Index


Musculoskeletal Diseases | Rheumatology | Skin and Connective Tissue Diseases



PATIENTS with rheumatoid arthritis (RA) are at increased risk of developing comorbid conditions.

OBJECTIVES: To evaluate the prevalence of comorbidities and compare their management in RA patients from different countries worldwide.

METHODS: STUDY DESIGN: international, cross-sectional.

PATIENTS: consecutive RA patients.

DATA COLLECTED: demographics, disease characteristics (activity, severity, treatment), comorbidities (cardiovascular, infections, cancer, gastrointestinal, pulmonary, osteoporosis and psychiatric disorders).

RESULTS: Of 4586 patients recruited in 17 participating countries, 3920 were analysed (age, 56+/-13 years; disease duration, 10+/-9 years (mean+/-SD); female gender, 82%; DAS28 (Disease Activity Score using 28 joints)-erythrocyte sedimentation rate, 3.7+/-1.6 (mean+/-SD); Health Assessment Questionnaire, 1.0+/-0.7 (mean+/-SD); past or current methotrexate use, 89%; past or current use of biological agents, 39%. The most frequently associated diseases (past or current) were: depression, 15%; asthma, 6.6%; cardiovascular events (myocardial infarction, stroke), 6%; solid malignancies (excluding basal cell carcinoma), 4.5%; chronic obstructive pulmonary disease, 3.5%. High intercountry variability was observed for both the prevalence of comorbidities and the proportion of subjects complying with recommendations for preventing and managing comorbidities. The systematic evaluation of comorbidities in this study detected abnormalities in vital signs, such as elevated blood pressure in 11.2%, and identified conditions that manifest as laboratory test abnormalities, such as hyperglycaemia in 3.3% and hyperlipidaemia in 8.3%.

CONCLUSIONS: Among RA patients, there is a high prevalence of comorbidities and their risk factors. In this multinational sample, variability among countries was wide, not only in prevalence but also in compliance with recommendations for preventing and managing these comorbidities. Systematic measurement of vital signs and laboratory testing detects otherwise unrecognised comorbid conditions.


comorbidities, rheumatoid arthritis

DOI of Published Version



Dougados M, Soubrier M, Antunez A, Balint P, Balsa A, Buch MH, Casado G, Detert J, El-Zorkany B, Emery P, Hajjaj-Hassouni N, Harigai M, Luo SF, Kurucz R, Maciel G, Mola EM, Montecucco CM, McInnes I, Radner H, Smolen JS, Song YW, Vonkeman HE, Winthrop K, Kay J. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis. 2014 Jan;73(1):62-8. doi: 10.1136/annrheumdis-2013-204223. Epub 2013 Oct 4. PubMed PMID: 24095940; PubMed Central PMCID: PMC3888623. Link to article on publisher's site

Journal/Book/Conference Title

Annals of the rheumatic diseases

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Link to Article in PubMed

PubMed ID


Creative Commons License

Creative Commons Attribution-Noncommercial 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 3.0 License