Rheumatic Disease Comorbidity Research Articles

Diabetes mellitus in rheumatic diseases: clinical characteristics and treatment considerations.

New pathophysiological insights are now available on comorbidities in rheumatic diseases (RDs). Several nationwide studies point to the fact that comorbid diabetes mellitus (DM) increases the risk of adverse outcomes in patients with various RDs. Genetic factors, intensity of systemic inflammation, anti-inflammatory potential of therapeutic agents, and duration of RDs have been insufficiently explored in the context of comorbidities. Some disease-modifying antirheumatic drugs (DMARDs) have demonstrated a potential to improve the glycemic control while glucocorticoids (GCs) have worsened it, particularly in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Anti-TNFalpha agents in combination with hydroxychloroquine (HCQ) have been associated with a reduced risk of DM in patients with RA, ankylosing spondylitis (AS), Sjögren syndrome (SS), and SLE. Better understanding of confounding factor of currently available antirheumatic therapies in patients with DM and RDs willpave the way for a tailored approach, limiting the severity of clinical manifestations and reducing the mortality risk.

The Potential Role of Spa Therapy in Managing Frailty in Rheumatic Patients: A Scoping Review.

Frailty is not limited to the elderly, as patients with rheumatic diseases can also experience this condition. The present scoping review aimed to investigate the possibility of using the health resort setting as an alternative location for managing rheumatic patients with frailty. The research resulted in finding several in vitro, in vivo, and clinical studies, resulting in evidence supporting the effectiveness of spa treatments in reducing pain, improving function, and managing comorbidity in rheumatic diseases. Additionally, spa treatments were demonstrated to modulate the MAPK/ERK pathway and the NF-kB pathway's activation and to reduce proinflammatory molecules' secretion in rheumatic diseases, thus suggesting their potential effective role in the regulation of inflammaging in frailty. Moreover, the health resort setting may offer potential resources to reduce risk factors, such as drug consumption, inactivity, and disease severity, and may serve as a setting for developing prevention protocols for frailty. Future research should explore innovative approaches, such as exercise training and early diagnostics, for the overall management of frailty in rheumatic patients in the spa setting.

Relationship Between Familial Mediterranean Fever and Other Rheumatic Diseases: Coincidence or Coexistence?

Background: Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease affecting mainly the ethnic groups of the Mediterranean basin. It has been reported that it can coexist with various systemic inflammatory diseases. This study aimed to obtain information on rheumatic diseases that accompany FMF and evaluate the relation between FMF and such diseases.
 Methods: Eighty-four patients diagnosed with FMF and have rheumatic disease comorbidity in the rheumatology clinic between January 2018 - March 2020 were included in this study. 
 Results: The most common accompanying rheumatic disease was spondyloarthritis with 36 patients. Vasculitides was the second common disease accompanying FMF with 22, followed by connective tissue disease in 13, rheumatoid arthritis in 5, juvenile idiopathic arthritis in 4, gout in 3, and hidradenitis suppurativa in 1 patients. The most common MEFV mutation observed was M694V. There was no significant difference in demographic characteristics and clinical manifestations between M694V mutation types. 
 Conclusions: In this study, the relation between FMF and various rheumatic diseases was determined. Two new conditions, eosinophilic granulomatous polyangiitis, and scleroderma were detected. The associations may be just coincidental or an extension of the common underlying pathology. To be aware of this association is important to early diagnosis and appropriate treatment.

Glucocorticoid-induced osteoporosis-Focus treatment (part1)

With afracture prevalence of 30-50%, glucocorticoid (GC)-induced osteoporosis is one of the most important comorbidities in inflammatory rheumatic diseases. Because of a reduction of bone quality with a lack of correlation with bone mineral density, the fracture risk during long-term GC treatment is not sufficiently represented by the currently available methods of osteodensitometry and therefore underestimated. According to the Confederation for Osteology (DVO) guidelines, abaseline osteological diagnosis including osteodensitometry is indicated in all postmenopausal women and in men aged 60years and older who receive or are scheduled to receive GC at adose of ≥ 2.5 mg prednisolone equivalent/day for > 3months. Basic measures in GC-treated patients include vitaminD and calcium supplementation as well as measures to promote muscle strength and coordination and to prevent falls. The indications for a specific osteological treatment depend on the calculated GC dose, age, sex, and other fracture risk factors in addition to bone mineral density and prevalent fractures.

POS1014 CENTRAL SENSITIZATION HAS MAJOR IMPACT ON QUALITY OF LIFE IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

Background:Maintaining optimal health-related quality of life (QoL) is the ultimate goal of treatment in axial spondyloarthritis (axSpA). Chronic pain has a large potential impact on QoL. Central sensitization (CS) may explain part of the chronic pain in axSpA. However, the role of central sensitization (CS) herein has only been studied to a limited degree and current axSpA guidelines pay little attention to identification and treatment of CS.Objectives:To explore the relationship between CS and QoL in axSpA.Methods:Consecutive outpatients with axSpA from the Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort were included. CS was assessed with the Central Sensitization Inventory (CSI; 0-100), QoL with the AS Quality of Life questionnaire (ASQoL; 0-18) and disease activity with the AS Disease Activity Score (ASDASCRP). A high probability of CS was defined as CSI score ≥40 and active disease as ASDASCRP score ≥2.1. Patient characteristics and clinical assessments were compared between groups with CSI score <40 and ≥40.(1) Multivariable regression analysis was conducted to investigate the relationship between CSI and ASQoL scores, correcting for potential confounders.Results:Of the 178 axSpA patients with available CSI score, 149 completed the ASQoL. Mean age of the 178 included patients was 47.4 ± 14.1 years, 78 (44%) were female, mean symptom duration was 21.4 ± 13.6 years and 88 (52%) were using bDMARDS. Mean CSI score was 38.0 ± 14.1, mean ASQoL 6.0 ± 5.3 and mean ASDASCRP 2.1 ± 1.0. CSI score ≥40 was significantly associated with higher mean ASQoL (9.7 vs. 3.3), higher mean ASDASCRP (2.6 vs. 1.7), female gender (60% vs. 29%) and more often entheseal involvement (61% vs. 26%) (Table 1).Table 1.Selection of patient characteristics, disease activity and clinical outcome variables for patients with axSpA, divided in subgroups for CSI score with a cutoff point of 40.CharacteristicsAll patientsn = 178CSI<40n = 98 (55%)CSI≥40n = 80 (45%)Age (years)47.4 ± 14.148.7 ± 15.045.8 ± 12.7Female78 (44)27 (29)44 (60)*Symptom duration (years)21.4 ± 13.621.5 ± 13.521.2 ± 13.8HLA-B27+133 (79)70 (79)54 (79)Smoker45 (27)28 (32)15 (23)BMI (kg/m2)26.7 ± 5.026.2 ± 4.427.5 ± 5.8Completed higher education181 (71)48 (70)34 (76)Biological use88 (52)49 (52)39 (51)RDCI (0-9)0.0 (0.0 – 1.0)0.0 (0.0 – 1.0)0.0 (0.0 – 1.8)Peripheral arthritis210 (6)5 (6)5 (8)Entheseal involvement364 (40)23 (26)38 (61)*ASDASCRP2.1 ± 1.01.7 ± 0.92.6 ± 1.0*CRP (mg/ml)2.9 (1.1 – 6.8)2.6 (1.1-6.0)3.6 (1.4 – 7.0)ASQoL (0-18)6.0 ± 5.33.3 ± 3.69.7 ± 4.9*CSI (0-100)38.0 ± 14.128.0 (23 – 34)50.0 (43.0 –56.0)N/AValues are n (%), mean ± SD or median (IQR).1International Standard Classification of Education (ISCED) level >4; 2Swollen Joint Count >0; 3Maastricht Ankylosing Spondylitis Enthesitis Score >0. *p<0.001. ASDASCRP: Ankylosing Spondylitis Disease Activity Score; ASQoL: Ankylosing Spondylitis Quality of Life questionnaire; CRP: C-reactive protein; CSI: Central Sensitization Inventory; RDCI: Rheumatic Disease Comorbidity Index.Patients with low ASDASCRP (<2.1) and also low CSI score (<40) showed good QoL (median ASQoL 1.1). Patients with low ASDASCRP combined with high CSI score (≥40) and patients with high ASDASCRP (≥2.1) combined with low CSI score reported worse QoL (median ASQoL 5.6 and 4.1, respectively). Patients with high ASDASCRP and also high CSI score reported the worst QoL (median ASQoL 12.0). (Figure 1).Figure 1.ASQoL score in patients with axSpA with CSI score ≥40 and <40, divided for ASDASCRP (cutoff 2.1)Additionally, in univariable analysis, the CSI score explained a large proportion of the variation of the ASQoL (R2=0.46). This association remained significant after correction for ASDASCRP, gender, symptom duration, entheseal involvement, smoking status, BMI category, educational level and comorbidities in multivariable analysis (CSI p<0.001).Conclusion:In daily clinical practice, CS seems strongly related to patient-reported QoL in patients with long-term axSpA.

Comorbidities in rheumatic diseases need special consideration during the COVID-19 pandemic.

Comorbidities in rheumatic and musculoskeletal diseases (RMDs) not only increase morbidity and mortality but also confound disease activity, limit drug usage and increase chances of severe infections or drug-associated adverse effects. Most RMDs lead to accelerated atherosclerosis and variable manifestations of the metabolic syndrome. Literature on COVID-19 in patients with RMDs, and the effects of various comorbidities on COVID-19 was reviewed. The initial data of COVID-19 infections in RMDs have not shown an increased risk for severe disease or the use of different immunosuppression. However, there are some emerging data that patients with RMDs and comorbidities may fare worse. Various meta-analyses have reiterated that pre-existing hypertension, cardiovascular disease, stroke, diabetes, chronic kidney disease, heart failure, lung disease or obesity predispose to increased COVID-19 mortality. All these comorbidities are commonly encountered in the various RMDs. Presence of comorbidities in RMDs pose a greater risk than the RMDs themselves. A risk score based on comorbidities in RMDs should be developed to predict severe COVID-19 and death. Additionally, there should be active management of such comorbidities to mitigate these risks. The pandemic must draw our attention towards, and not away from, comorbidities.

Prevalence and pattern of comorbidities in chronic rheumatic and musculoskeletal diseases: the COMORD study

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.

Osteoporosis-frequent comorbidity in patients with rheumatism

Osteoporosis is one of the most frequent comorbidities in inflammatory rheumatic diseases. The immune system is substantially involved in the regulation of bone homeostasis and chronic inflammatory diseases influence this equilibrium at several levels. Besides the immunologically mediated inflammatory activity, immobility and glucocorticoid treatment are further risk factors for osteoporosis. Diagnostic and therapeutic recommendations are based on the current guidelines for osteoporosis of the Governing Body on Osteoporosis (DVO). Monitoring of the risk factors and bone mineral density testing is meaningful in each patient with a newly diagnosed rheumatic disease. In the case of aT-score ≤-1.5 aspecific drug treatment with bisphosphonates, teriparatide or denosumab should be started together with optimizing preventive measures, such as reduction of glucocorticoid dosage, calcium and vitamin D intake and life style modifications. The risk of osteonecrosis of the jaw (ONJ) in patients with osteoporosis is small; however, there appears to be asignificant increase in multiple vertebral fractures after discontinuation of denosumab.

Malignancy as a comorbidity in rheumatic diseases: a retrospective hospital-based study.

Patients with Rheumatic diseases (RDs) are at an increased risk of malignancies compared with the general population. The aim of this study was to examine the relative frequency of several cancers in a single homogeneous cohort of patients with different RDs. Patients diagnosed with rheumatoid arthritis (RA), Ankylosing spondylitis (AS), Sjögren's syndrome (SS), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), dermatomyositis (DM), or polymyositis were included. Out of 3982 adult residents admitted to the division of rheumatology, 61 malignancies were observed. The 2009 National Central Cancer Registry (NCCR) of China served as the reference for calculating standardized ratio (SR). The malignancy frequency had no difference between RDs with malignancy and the general population. Patients with SS and DM/PM showed an increased risk of non-Hodgkin's lymphoma (SR for SS patients=9.709, 95% confidence interval (CI)=4.602 to 17.916; SR for DM/PM=35.714, 95% CI=25.001 to 49.527). Patients with DM/PM and SSc showed an increased risk of lung cancer (SR for DM/PM=10.638, 95% CI=5.245 to 19.131; SR for SSc patients=7.752, 95% CI=3.295 to 15.309). Patients with SS and DM/PM showed an increased risk of ovary cancer (SR for SS patients=8.177, 95% CI=3.566 to 15.888; SR for DM/PM=32.258, 95% CI=22.126 to 45.490). Patients with SLE showed an increased risk of cervix cancer (SR for AS patients=6.897, 95% CI=2.748 to 14.144). Patients with AS showed an increased risk of pancreas cancer (SR for AS patients=7.576, 95% CI=2.181 to 15. 071). Different RDs have an increased risk of particular cancers. Among hematologic cancers, the risk of non-Hodgkin's lymphoma was higher than general population. Among solid tumors, the risk of cancers of the lung, ovary, cervix, and pancreas was higher than general population.

PM212 Rheumatic Heart Disease Co-Morbidity in Heart Failure, Atrial Fibrillation and Stroke Among Adult Aboriginal Western Australians: Need for Service Strengthening

PM212 Rheumatic Heart Disease Co-Morbidity in Heart Failure, Atrial Fibrillation and Stroke Among Adult Aboriginal Western Australians: Need for Service Strengthening

Indexing rheumatology journals: filling gaps in the publishing landscape

Over the past decades, rheumatology has shaped as a rapidly developing scientific discipline with a wide range of interests and evolving priorities. Initial reports on the use of the first generation of biological agents for rheumatoid arthritis and other inflammatory rheumatic diseases in the early 2000s opened up new avenues for research at the interface of immunology, medical chemistry, and rheumatology. By improving the outcomes of suppressing autoimmunity and inflammation, rheumatologists across the world have increased the lifespan of their patients and encountered a number of new challenges. One such challenge is comorbidity, which necessitates multidisciplinary approach to rheumatic diseases, implementation of knowledge and skills from allied fields of science (i.e., cardiology, oncology, hematology). Authors of research studies covering the issue of comorbidity in rheumatic diseases are now targeting not only periodicals in rheumatology but also in allied fields of science with editorial and reviewer boards competent to process multidisciplinary research reports.

Cardiovascular comorbidity in rheumatic diseases.

Patients with rheumatoid arthritis (RA) and other inflammatory joint diseases (IJDs) have an increased risk of premature death compared with the general population, mainly because of the risk of cardiovascular disease, which is similar in patients with RA and in those with diabetes mellitus. Pathogenic mechanisms and clinical expression of cardiovascular comorbidities vary greatly between different rheumatic diseases, but atherosclerosis seems to be associated with all IJDs. Traditional risk factors such as age, gender, dyslipidaemia, hypertension, smoking, obesity and diabetes mellitus, together with inflammation, are the main contributors to the increased cardiovascular risk in patients with IJDs. Although cardiovascular risk assessment should be part of routine care in such patients, no disease-specific models are currently available for this purpose. The main pillars of cardiovascular risk reduction are pharmacological and nonpharmacological management of cardiovascular risk factors, as well as tight control of disease activity.

Коморбидность при ревматических заболеваниях у подростков. Обзор литературы и собственные наблюдения

Коморбидность при ревматических заболеваниях у подростков. Обзор литературы и собственные наблюдения

Hot topics in modern rheumatology

The Expert Council for Tofacitinib (TOFA) and two symposiums on New Possibilities for Targeted Therapy of Rheumatoid Arthritis and on Success Factor of Biological Therapy for Rheumatic Diseases were held within the annual scientific-and-practical conference of the V.A. Nasonova Research Institute of Rheumatology on Comorbidity in Rheumatic Diseases in Moscow on 14–15 October 2014.

THE CONCEPT OF MULTIMORBIDITY IN RHEUMATOLOGIC PRACTICE

The undoubted and legitimate interest of investigators in comorbidities in rheumatic diseases has not faded in the past decade; however, the concept of multimorbidity has not yet been integrated into either clinical practice or rheumatology researches. The terms comorbidity and multimorbidity are frequently and not always consciously used as interchangeable, which leads to some confusion in their terminology and accordingly in the development of further research strategies. The concepts of concurrent pathology and multimorbidity are not mutually exclusive or contradictory to each other, but they should be considered from another point of view than comorbidity. The problem of multimorbidity disease is a rule rather than an exception to clinicians who are engaged in the treatment of mainly typical patients with rheumatic diseases. Recent researches could outline few key areas to further study the conception of multimorbidity in rheumatology practice, which would be able to turn international rheumatology research community from rheumatic disease to the patient as a whole.

Cardiovascular comorbidity in rheumatic diseases: a focus on heart failure.

Rheumatic diseases are associated with an increased risk of cardiovascular (CV) mortality attributed to a higher incidence of heart failure (HF) and ischemic heart disease. Although traditional CV risk factors contribute to the increased incidence seen in this population, by themselves they do not account for the increased risk; in fact, obesity and hyperlipidemia may play a paradoxic role. Immune-mediated mechanisms and chronic inflammation likely play a role in the pathogenesis of CV disease in patients with rheumatic diseases. The usual clinical features of ischemic heart disease and HF are less likely to be seen in this patient population.

SP0097 Comorbidity in rheumatic diseases

What is “comorbidity”? All other diseases that co-exist with a disease of interest, are called comorbidities. Comorbidities in inflammatory rheumatic diseases can be associated with persistent inflammatory activity or disease...

FRI0195 Treatment with anti-tnf biologics in patient with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis does not increase the risk of malignancy

BackgroundSystemic inflammatory rheumatic diseases, may increase the risk of malignancy, and in particular of lymphoproliferative disorders1. If anti-TNFα therapy is associated with this risk is still controversial2,3.ObjectivesThe aim of this...

SP0024 Comorbidity in Rheumatic Diseases

Successful minimization of the consequences of co-morbidities in RA is a multi-step process that requires and understanding of: (i) which these major co-morbidities are, (ii) which their typical manifestations are,...

SP0158 Comorbidity in Rheumatic Diseases

More than half of the patients with rheumatoid arthritis seen in daily care have one or more comorbid conditions. These may be coincidental medical conditions as expected in the age...