{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T19:13:48Z","timestamp":1791054828152,"version":"4.1.0"},"reference-count":32,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"unspecified","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["R01 AR46849"],"award-info":[{"award-number":["R01 AR46849"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["AG 058738"],"award-info":[{"award-number":["AG 058738"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01 AG068192"],"award-info":[{"award-number":["R01 AG068192"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2025,7,14]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To examine associations between multimorbidity, the social determinants of health (SDoHs) and rheumatoid arthritis (RA) flare and remission.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All patients aged \u226518 years in Olmsted County, Minnesota, with incident RA in 1999\u20132014 were identified. Using a list of 55 chronic medical conditions, multimorbidity was defined as the presence of \u22652 conditions and substantial multimorbidity as \u22655 conditions. The Area Deprivation Index and Social Vulnerability Index (SVI) were used as proxies for adverse SDoH burden. Flare and remission were defined using Outcome Measures in Rheumatoid Arthritis Clinical Trials definitions. Mixed effects models were used to assess associations between flare\/remission and multimorbidity, adverse SDoH burden and other patient characteristics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>This study included 659 patients with incident RA. Multimorbidity and substantial multimorbidity predicted 29% (OR:1.29, 95%\u2009CI:1.04 to 1.59) and 26% (OR:1.26, 95%\u2009CI:1.03 to 1.53) higher odds of flare, respectively. Both were associated with 34% (OR:0.66, 95%\u2009CI:0.49 to 0.90) and 33% (OR:0.67, 95%\u2009CI:0.51 to 0.90) lower odds of remission, respectively. SVI predicted 8% lower odds of remission for every 0.1 increase above 0.3 (OR:0.92, 95%\u2009CI:0.85 to 0.99). Flare was also associated with female sex, smoking, younger age and shorter disease duration, but not seropositivity. Remission was also associated with male sex, never smoking, older age and longer disease duration, but not seropositivity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Multimorbidity predicts higher odds of RA flare and lower odds of remission. Adverse SDoH burden predicts lower odds of remission. These findings have the potential to inform disease prognostication and clinician interventions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-005577","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T18:25:41Z","timestamp":1754418341000},"page":"e005577","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Multimorbidity burden predicts lower likelihood of remission and higher likelihood of disease flare in patients with rheumatoid arthritis"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2503-7737","authenticated-orcid":false,"given":"Daniel","family":"Montes","sequence":"first","affiliation":[{"name":"Internal Medicine, Mayo Clinic, Rochester, Minnesota, 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