Background/Purpose: comorbidity in rheumatoid arthritis (RA) is very important because it might delay diagnosis and influence treatment decisions. It is usually related to complications, alters survival, outcomes and confounds analysis. Moreover, managing care for patients with several chronic conditions currently represents one of the greatest challenges to health care systems. The aim of this study was to to develop evidence based recommendations for the diagnosis and management of comorbidity in RA in daily practice

Methods: four systematic literature reviews, following the guidelines of the Cochrane Collaboration were performed by 4 evidence reviewers, a librarian and two methodologists, to identify comorbidity indexes or scales and to assess the prevalence, mortality, impact on quality of life and costs of comorbidity in RA. Evidence from other consensus, relevant publications and available clinical guidelines was also revised. Comorbidity included co-existent diseases as well as complications of RA or RA therapies. This evidence was discussed in two different meetings, summarized and recommendations were finally formulated by a task force comprising 16 expert rheumatologists and 2 methodologists. The level of evidence and strength of recommendation were classified according to the Center for Evidence Based Medicine of Oxford. The level of agreement was established through Delphi technique. 

Results: the consensus covers: 1) which comorbidities and how they should be identified in clinical practice in the first and following visits (including treatments, risk factors and/or patient´s features that might interfere with RA management); 2) specific recommendations on comorbidities related and not to RA, including major adverse events of RA treatment;  3) disease prevention and health promotion (general and musculoskeletal health); 4) when comorbidities management should be referred and/or shared with other specialities and who with: primary care, other specialists, etc.; 5) specific recommendations to assure an integral care approach for RA patients with any comorbidity: health care models for chronic inflammatory patients, early arthritis units, primary care relationships, specialized nursing care, self-management.

Conclusion: these recommendations are intended to provide rheumatologists, patients and other stakeholders with a consensus on the diagnosis and management of comorbidity in RA, in order to improve the final disease outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/consensus-statement-on-the-diagnosis-and-management-of-comorbidity-in-rheumatoid-arthritis/