Co-morbidities in established rheumatoid arthritis

Area of Science:

• Rheumatology
• Internal Medicine
• Clinical Epidemiology

Background:

• Co-morbid conditions are prevalent in rheumatoid arthritis (RA) patients.
• While standardized indexes exist, clinical practice often involves simple recording of co-morbidities.
• These co-morbidities, whether causally linked to RA or treatment-related, significantly increase disability and mortality.

Purpose of the Study:

• To highlight the critical impact of co-morbidities on rheumatoid arthritis (RA) patients.
• To emphasize the importance of managing co-morbidities for improving patient quality of life and reducing RA mortality.
• To discuss the iatrogenic aspects of co-morbidities arising from RA treatments.

Main Methods:

• Review of existing literature and clinical observations regarding co-morbidities in RA.
• Analysis of the impact of various co-morbidities (cardiac, gastrointestinal, chest, osteoporosis, periodontal disease) on RA patients.
• Discussion on the role of RA treatments in the development or exacerbation of co-morbidities.

Main Results:

• Cardiac co-morbidities represent a major concern due to their frequency and adverse health effects.
• Gastrointestinal, chest, and bone-related co-morbidities (osteoporosis, fractures) are common, often linked to drug therapies.
• Iatrogenic co-morbidities, resulting from immunosuppressive treatments like conventional disease-modifying drugs and biologics, pose significant risks.

Conclusions:

• Optimal RA care necessitates comprehensive assessment and management of associated co-morbidities, including risk factor modification.
• Reducing RA inflammation and managing cardiac risk factors are crucial for mitigating cardiac co-morbidities.
• Balancing the risks of RA treatments against the benefits is essential, particularly concerning iatrogenic co-morbidities and associated infections or liver disease.