Comorbidities in Rheumatoid and Osteoarthritis

To recognize the comorbidities such as anxiety (ANX), depression (DEP), and fibromyalgia (FM) associated with rheumatoid arthritis (RA) and osteoarthritis (OA) in routine care practice, current research has discovered a new screening procedure called Multidimensional Health Assessment Questionnaire (MDHAQ) to detect patient status, prognosis, and response to treatments.

The study published in ACR Open Rheumatology proposes a high prevalence of ANX, DEP, and FM about 40% in patients with OA and 36% in patients with RA. Furthermore, the study found strong associations of these comorbidities with poorer patient status, all assessed using a single Multi-Dimensional Health Assessment Questionnaire (MDHAQ).

Additionally, researchers indicated that the MDHAQ can be seamlessly integrated into routine clinical care for assessing comorbidities associated with RA and OA.

OA and RA are often linked to ANX, DEP, and FM, and despite the high prevalence of these comorbidities, it is difficult to recognize by physicians in routine practice. To assess the comorbidities, multiple questionnaires are required, which seems to be problematic.

To solve this issue, MDHAQ was designed which incorporated 4 indices within it, which are:

• RAPID3 to assess overall patient status
• Fibromyalgia Assessment Screening Tool (FAST4)
• MDHAQ DEP screen (MDS2)
• MDHAQ ANX screen (MAS2)

The advantage of this approach is that it involves a single questionnaire that can be easily completed by patients in 5 to 10 minutes to screen for ANX, DEP, and FM.

To assess the reliability of MDHAQ, Juan Schmukler, Rush University Medical Center, Chicago, Illinois, and colleagues undertook a retrospective analysis of MDHAQ data in unselected patients with OA or RA receiving routine care at one setting included four indices within an MDHAQ: MDHAQ ANX screen, MDHAQ DEP screen, Fibromyalgia Assessment Screening Tool, and RAPID3.

Unadjusted and age-adjusted (Mantel-Haenszel) odds ratios (ORs) were used to evaluate the prevalence of each comorbidity and associations with RAPID3 and its components function, pain, and patient global scores.

Study Findings

• 40.4% of 361 patients with OA and 36.3% of 488 patients with RA screened positive for ANX, DEP, and/or FM (8.1% and 7% for all three)
• RAPID3 and each component were elevated in patients with positive screen results for ANX, DEP, and/or FM in both diagnoses (ORs of 2.6–35.8).

In conclusion, researchers approved the reliability of using a single MDHAQ to screen three common comorbidities linked with RA and OA.

Furthermore, they urged conducting studies related to pain mechanisms according to ANX, DEP, and FM that would give proper insights for understanding the pathophysiology and improving patient management and outcomes.

Reference: Schmukler J, Malfait AM, Block JA, Pincus T. 36-40% of Routine Care Patients With Osteoarthritis or Rheumatoid Arthritis Screen Positive for Anxiety, Depression, and/or Fibromyalgia on a Single MDHAQ. ACR Open Rheumatol. 2024 Jul 16. doi: 10.1002/acr2.11711. Epub ahead of print. PMID: 39011669