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Comorbidities in rheumatoid arthritis

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Rheumatoid arthritis (RA) is often characterized by the burden of swollen joints, pain, and decreased physical function, but less understood are the many manifestations of additional health conditions that are associated with RA and its treatments. First brought to light with observations of increased mortality in RA, studies noted the increased rates of cardiovascular and infection events. The chronic, debilitating, autoimmune nature of RA affects the patient directly or indirectly in almost all organ systems, from cardiovascular problems and infections to depression and gastrointestinal ulcers. On average, the established RA patient has two or more comorbid conditions. It should be the responsibility of the rheumatologist to take these and the risk of additional conditions into account when treating the patient. This chapter reviews important comorbidities in patients with RA, their prevalence, and their relation to RA.

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Comorbidity and rheumatoid arthritis

A comorbid condition is another medical condition that is present in addition to rheumatoid arthritis (RA). Comorbidity can be further defined in terms of a current (recent) or past condition, and the comorbid condition described might represent an active, past or transient illness. Ongoing interstitial lung disease, previous malignancies and past influenza are respective examples of such states.

In this chapter we cite selectively from the voluminous literature of comorbidity in patients with

Why is comorbidity of interest in rheumatoid arthritis?

Physicians and researchers are interested in comorbidity because of its effect on quality of life (QOL) and on RA prognosis and outcome. Using the NDB index of comorbid conditions (an index of how medically ill the patient is), the number of comorbid conditions is directly related to QOL as measured by the EuroQoL (Figure 1).2, 3 Although it is common to think of functional status in RA as being related primarily to RA, functional status is also strongly influenced by comorbid illness (Figure 2

The evaluation and measurement of comorbidity

Under many circumstances, the number of different comorbid conditions as a measure of comorbidity burden has important prognostic value. For example, individuals with cardiovascular, pulmonary and renal disease have worse prognoses for almost any outcome than individuals with only one of these conditions. This has led to the development of indices that provide a ‘comorbidity score’ (Table 2). As might be obvious, different comorbid conditions have different prognostic values. For example,

Specific comorbid conditions

The associations of specific comorbidities and RA are shown in Table 4.

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