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The association between polypharmacy and disease control in rheumatoid arthritis and systemic lupus erythematosus: a cohort study

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Abstract

Polypharmacy can be associated with poor outcomes in chronic diseases. Our objective is to determine the prevalence of polypharmacy and its association with disease control in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). An observational study was conducted using the SARD database of the CHU de Québec. Participants newly diagnosed with RA or SLE enrolled in the database after 24 months were included. Collected data included number and type of medications, Charlson Comorbidity Index, and medication adherence (proportion of days covered during the first 180 days). Polypharmacy was defined as the simultaneous use ≥5 medications. Multivariable logistic and linear regressions were used to determine the association between polypharmacy and disease control (DAS28CRP, SLEDAI-2 K). The study included 111 participants (RA = 81; SLE = 30). Medication count increased at two years in RA (mean ± SD): 4.6 ± 3.3 to 6.9 ± 3.6; and SLE: 6.5 ± 4.6 to 7.80 ± 4.82. Polypharmacy prevalence increased at two years: RA: from 43 to 74%; SLE: from 47 to 73%. Mean medication adherence exceeded 85%. For RA participants, polypharmacy was associated with a better DAS28CRP score at one year [adjusted odds ratio of achieving a poor outcome: 0.17 (95%CI 0.04–0.71)], but this association was lost at two years [2.88 (0.45–18.29)]. For SLE, polypharmacy was not associated with disease activity based on the SLEDAI-2 K at one year [7.36 (0.26-211.16)] or two years [0.32 (0.05–1.99)]. Overall, polypharmacy is very prevalent in RA and SLE and could be positively associated with the level of disease control in the year after a diagnosis of RA.

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Acknowledgements

Dr. Paul R. Fortin is supported by a Tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases. Caroline Sirois was recipient of Junior 2 Research Scholar from the Fonds de Recherche du Québec – Santé (FRQS).

Funding

The SARD biobank and database (SARD BDB) of the CHU de Québec-Université Laval is supported by the Fondation du CHU de Québec-Université Laval.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, Université Laval, Québec, Canada

    William Berthelot, Louis Bessette, Philippe Desaulniers, Marie-Claude Audet, Sonia Lagacé & Paul R. Fortin

  2. Centre ARThrite, Université Laval, Québec, Canada

    William Berthelot, Nathalie Amiable, Philippe Desaulniers & Paul R. Fortin

  3. Infectious Diseases and Immunity Research Division, CHU de Québec, Université Laval Research Centre, Québec, Canada

    William Berthelot, Nathalie Amiable & Paul R. Fortin

  4. Faculty of Pharmacy, Université Laval, Québec, Canada

    Caroline Sirois

  5. Department of Mathematics and Statistic, Université Laval, Québec, Canada

    Anne-Sophie Julien

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An earlier version of the abstract before final analysis was presented at the Canadian Rheumatology Association 2023 Annual Scientific Meeting: Berthelot W, Sirois C, Julien AS, Amiable N, Fortin PR (2023) Polypharmacy in Systemic Autoimmune Rheumatic Diseases. Canadian Rheumatology Association Meeting Quebec City Convention Centre Quebec City, Quebec, Canada February 8–11, 2023. J Rheumatol 50(7 Suppl 1):7-100. https://doi.org/10.3899/jrheum.2023-0216.

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Berthelot, W., Sirois, C., Julien, AS. et al. The association between polypharmacy and disease control in rheumatoid arthritis and systemic lupus erythematosus: a cohort study. Rheumatol Int 45, 44 (2025). https://doi.org/10.1007/s00296-025-05804-8

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