Abstract
Objective. Comorbidities such as cardiovascular diseases (CVD), cancer, osteoporosis, and depression are often underrecognized in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or psoriasis (PsO). Recommendations may improve identification and treatment of comorbidities. The Canadian Dermatology-Rheumatology Comorbidity Initiative reviewed the literature to develop practical evidence-based recommendations for management of comorbidities in patients with RA, PsA, and PsO.
Methods. Eight main topics regarding comorbidities in RA, PsA, and PsO were developed. MEDLINE, EMBASE, and the Cochrane Library (1960–12/2012), together with abstracts from major rheumatology and dermatology congresses (2010–2012), were searched for relevant publications. Selected articles were analyzed and metaanalyses performed whenever possible. A meeting including rheumatologists, dermatologists, trainees/fellows, and invited experts was held to develop consensus-based recommendations using a Delphi process with prespecified cutoff agreement. Level of agreement was measured using a 10-point Likert scale (1 = no agreement, 10 = full agreement) and the potential effect of recommendations on daily clinical practice was considered. Grade of recommendation (ranging from A to D) was determined according to the Oxford Centre for Evidence-Based Medicine evidence levels.
Results. A total of 17,575 articles were identified, of which 407 were reviewed. Recommendations were synthesized into 19 final recommendations ranging mainly from grade C to D, and relating to a large spectrum of comorbidities observed in clinical practice: CVD, obesity, osteoporosis, depression, infections, and cancer. Level of agreement ranged from 80.9% to 95.8%.
Conclusion. These practical evidence-based recommendations can guide management of comorbidities in patients with RA, PsA, and PsO and optimize outcomes.
Footnotes
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AbbVie sponsored a meeting on the management of comorbidities, held in Toronto, Ontario, Canada, on May 31 to June 1, 2013. This publication summarizes the results of the Canadian Dermatology-Rheumatology (DR) Comorbidity Initiative systematic literature searches (MEDLINE, EMBASE, Cochrane Library, 2010–2012 American College of Rheumatology, European League Against Rheumatism, American Academy of Dermatology, European Academy of Dermatology and Venereology abstracts) and consensus-based recommendations from that meeting. AbbVie provided funding to Pinnacle Marketing and Education Inc. to manage the Canadian DR Comorbidity Initiative that led to this paper. AbbVie paid consultancy fees to BH, JP, LB, SK, RB, WG, JD, CL, and JK for their participation in the Canadian DR Comorbidity Initiative. AbbVie paid Leading Edge for editorial support.
- Accepted for publication May 4, 2015.
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