Comorbidities in idiopathic inflammatory myopathies: population-based evidence on risk subgroups and implications for...

Idiopathic inflammatory myopathies (IIMs) carry substantial extra-muscular comorbidities. The purpose of this review is to provide a focused synthesis of recent population-based data on the epidemiology of key comorbidities in IIMs: atherosclerotic cardiovascular disease (ASCVD), venous thromboembolism (VTE), psychiatric and neurocognitive disorders, and bone health.

IIM patients have approximately two-fold increased risk of ASCVD and of other cardiovascular events, like VTE. These risks likely result from several factors, including chronic systemic inflammation, physical inactivity, treatment side effects. Anti-HMGCR immune necrotizing inflammatory myopathy (IMNM), is a subtype of IIM that requires special consideration regarding dyslipidemia management, where statin alternatives are necessary. Furthermore, psychiatric and neurocognitive comorbidities are common, and likely under-recognized among IIM patients, and perhaps especially so in inclusion body myositis (IBM) patients. Finally, IIM patients have an increased risk of accelerated bone loss likely due to systemic inflammation, muscle damage and physical inactivity, and glucocorticoid exposure.

Cardiovascular care, psychiatric/neurocognitive disorders, and osteopenia/osteoporosis are highly prevalent and often underrecognized in IIMs. Effective management of these IIM-associated comorbidities requires a multidisciplinary, comprehensive care approach, and further work is needed to adapt existing risk-stratification and screening tools for the unique needs of IIMs patients.