Introduction
In this study, we aimed to identify whether biologics treatment in
rheumatoid arthritis (RA) patients was capable of preventing
comorbidities in this population [1]. Biologics have been used for
more than 15 years in Taiwan, and their efficacy has been discussed
elsewhere and confirmed to be protective against joint structure damage
in RA patients. Whether biologics’ beneficial effect influences
comorbidities throughout the body is still under evaluation.
Among RA patients, the first comorbidities that need to be considered
are cardiovascular events, followed by metabolic problems like diabetes
and dyslipidemia. Diabetes mellitus, together with a number of risk
factors of metabolic origin, can result in an increased risk for early
mortality [2]. Considerable evidence has demonstrated that chronic
low-grade inflammation caused by activating the innate immune system is
vital in the pathogenesis of diabetes and other major complications.
Diabetes is also a risk factor for cardiovascular comorbidities itself.
In addition to these common comorbidities, RA is an autoimmune disease
that can overlap other rheumatic or orthopedic-related comorbidities,
such as gout, osteoporotic fractures, inflammatory bowel disease,
psoriasis, etc. In the long run, the malignancy could be devastating due
to chronic inflammation and tissue damage in RA patients.
Several other comorbidities that need to be considered include
infectious diseases caused by the immune deviation of RA patients or the
hepatic or nephrotic damage caused by medication side effects. Such
pulmonary diseases as interstitial lung disease, asthmatic bronchitis,
or chronic obstructive pulmonary disease are all listed in our analysis
(Table 1).
The purpose of this study was to determine the long-term effect of
biologic agents on RA patients in a real-world setting by using a
nationwide database. Therefore, we designed a simulated analytic cohort
study with strict selection and matching to determine whether long-term
biologic agent use could affect the overall mortality rate of RA
patients. In the current retrospective study, we compared the mortality
rate between biologics users and non-biologics users in RA patients in
Taiwan.