Abstract
Increased risk of comorbidities has been reported in Rheumatic and Musculoskeletal Diseases (RMD). We aimed to evaluate the prevalence and pattern of comorbidities in RMD patients nationwide, to identify multimorbidity clusters and to evaluate the gap between recommendations and real screening. Cross-sectional, multicentric nationwide study. Prevalence of comorbidities was calculated according to six EULAR axes. Latent Class Analysis identified multimorbidity clusters. Comorbidities’ screening was compared to international and local recommendations. In 769 patients (307 RA, 213 OA, 63 SLE, 103 axSpA, and 83 pSA), the most frequent comorbidities were cardiovascular risk factors and diseases (CVRFD) (hypertension 36.5%, hypercholesterolemia 30.7%, obesity 22.7%, smoking 22.1%, diabetes 10.4%, myocardial infarction 6.6%), osteoporosis (20.7%) and depression (18.1%). Three clusters of multimorbidity were identified: OA, RA and axSpA. The most optimal screening was found for CVRF (> = 93%) and osteoporosis (53%). For malignancies, mammograms were the most optimally prescribed (56%) followed by pap smears (32%) and colonoscopy (21%). Optimal influenza and pneumococcus vaccination were found in 22% and 17%, respectively. Comorbidities were prevalent in RMD and followed specific multimorbidity patterns. Optimal screening was adequate for CVRFD but suboptimal for malignant neoplasms, osteoporosis, and vaccination. The current study identified health priorities, serving as a framework for the implementation of future comorbidity management standardized programs, led by the rheumatologist and coordinated by specialized health care professionals.
Highlights
Rheumatic and musculoskeletal diseases (RMD) are universally prevalent chronic non-communicable diseases (NCD) with a significant contribution to the Global Burden of Diseases[1]
Patients were excluded if the current visit was their first visit to the rheumatologist of if they had an association of several Chronic Inflammatory Rheumatic Diseases (CIRDs)
Disease duration ranged from 84.5 months in OA to 103.5 months in rheumatoid arthritis (RA) (p = 0.013). 29.9% were previous or current smokers, 22.1% were current smokers (11.1% in systemic lupus erythematosus (SLE) to 28.2% in axial spondyloarthritis (axSpA), p < 0.001) and 2.9% drank alcohol regularly (1.6% in RA to 8.2% in axSpA, p = 0.562)
Summary
Rheumatic and musculoskeletal diseases (RMD) are universally prevalent chronic non-communicable diseases (NCD) with a significant contribution to the Global Burden of Diseases[1]. Most rheumatologists consider that it is their responsibility to assess these comorbidities, for several reasons[13,14] Some of these comorbidities are more frequently observed in patients with RMD in comparison to the general population. This is clearly the case for cardiovascular diseases[7,15,16,17], infections[18,19] and osteoporosis. RMD may be heterogeneous, they all seem to share the same healthcare resource utilization, with comorbidities accounting for a substantial proportion of the health costs across all RMD20,30
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