Prognostic value of comorbidity indices and lung diseases in early rheumatoid arthritis: a UK population-based study

Research output: Contribution to journalArticlepeer-review


  • Elena Nikiphorou
  • Simon De Lusignan
  • Christian Mallen
  • Jacqueline Roberts
  • Kaivan Khavandi
  • Gabriella Bedarida
  • James Galloway

Colleges, School and Institutes

External organisations

  • Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London
  • Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire
  • Pfizer Medical Affairs, Inflammation & Immunology, International Developed Markets, Pfizer, Tadworth, Surrey
  • Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK.
  • Research into Inflammatory Arthritis Centre Versus Arthritis instead of Versus Arthritis Centre of Excellence in the Pathogenesis of Rheumatoid Arthritis, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham
  • Centre for Rheumatic Diseases, King’s College London, London
  • Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH
  • Kings College University of London
  • University of Surrey


Objectives: We assessed comorbidity burden in people with rheumatoid arthritis (RA) at diagnosis and early disease (three years) and its association with early mortality and joint destruction. The association between lung disease and mortality in RA in not well studied; we also explored this relationship.

Methods: From a contemporary UK based population (n=1,475,762) we identified a cohort with incident RA (n=6,591). The prevalence of comorbidities at diagnosis of RA and at three years compared with an age and gender matched controls (n=6,591). In individuals with RA we assessed the prognostic value of the Charlson Comorbidity Index (CCI) and Rheumatic Disease Comorbidity Index (RDCI) calculated at diagnosis for all-cause mortality and joint destruction (with joint surgery as a surrogate marker). We separately evaluated the association between individual lung diseases (chronic obstructive pulmonary disease [COPD], asthma, and interstitial lung disease) and mortality.

Results: Respiratory disease, cardiovascular disease, stroke, diabetes, previous fracture, and depression were more common (p<0.05) in patients with RA at diagnosis than controls. Comorbidity (assessed using RDCI) was associated with all-cause mortality in RA (adjusted hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.00-1.60). There was no association with joint destruction. COPD, but not asthma, was associated with mortality (COPD HR 2.84, 95% CI 1.13-7.12).

Conclusion: There is an excess burden of comorbidity at diagnosis of RA including COPD, asthma and ILD. COPD is a major predictor of early mortality in early RA. Early assessment of comorbidity including lung disease should form part of the routine management of RA patients.


Original languageEnglish
JournalRheumatology (Oxford, England)
Early online date3 Oct 2019
Publication statusE-pub ahead of print - 3 Oct 2019


  • rheumatoid arthritis, mortality, joint damage, comorbidity, chronic obstructive pulmonary disease, asthma, cardiovascular diseases