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Prevalence and pattern of comorbidities in chronic rheumatic and musculoskeletal diseases: the COMORD study
Nelly Ziade1,2, Bernard El Khoury3, Marouan Zoghbi4
1Rheumatology department, Hotel-Dieu de France Hospital, Beirut, Lebanon. nellziade@yahoo.fr.
Insights
Rheumatic and Musculoskeletal Diseases (RMD) patients frequently have comorbidities like cardiovascular issues and osteoporosis. While screening for cardiovascular risks is good, it
Area of Science:
- Rheumatology
- Epidemiology
- Public Health
Background:
- Comorbidities are common in Rheumatic and Musculoskeletal Diseases (RMD).
- Understanding comorbidity patterns and screening gaps is crucial for patient care.
Purpose of the Study:
- To assess comorbidity prevalence and patterns in RMD patients nationwide.
- To identify multimorbidity clusters within RMD populations.
- To evaluate the discrepancy between recommended and actual comorbidity screening practices.
Main Methods:
- A cross-sectional, multicentric nationwide study involving 769 RMD patients.
- Prevalence of comorbidities analyzed across six EULAR axes.
- Latent Class Analysis used to identify multimorbidity clusters.
- Screening practices compared against international and local recommendations.
Main Results:
- Cardiovascular risk factors and diseases (CVRFD) were most frequent (e.g., hypertension 36.5%, hypercholesterolemia 30.7%).
- Osteoporosis (20.7%) and depression (18.1%) were also prevalent.
- Three distinct multimorbidity clusters identified: Osteoarthritis (OA), Rheumatoid Arthritis (RA), and axial Spondyloarthritis (axSpA).
- Optimal screening rates were high for CVRF (>93%) but suboptimal for malignancies (mammograms 56%), osteoporosis (53%), and vaccinations (influenza 22%, pneumococcus 17%).
Conclusions:
- Comorbidities are highly prevalent in RMD patients, exhibiting specific multimorbidity patterns.
- Screening for CVRFD is generally adequate, but screening for malignancies, osteoporosis, and vaccinations requires improvement.
- Findings provide a framework for standardized comorbidity management programs in RMD, led by rheumatologists.
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.
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