Article Figures & Data
Tables
- Table 1.
Recommendations of the Madrilenian Society of Rheumatology for the management of comorbidities in rheumatoid arthritis. From Roubille C, et al. Rheumatol Int 2015;35:445–58.
No. The Panel Recommends... %A LOE GOR 1 ...investigating comorbidities and risk factors with high incidence or mortality, especially those that may be potentially preventable, or that may interfere with the assessment of RA or its treatment*. 92 5 D 2 ...early diagnosis and treatment of comorbidity in patients with RA, as well as standardized followup. 90 4 D 3 ...optimizing the use of the clinical history, physical examination, and electronic information as major sources to identify and confirm comorbidities in RA. 89 5 D 4 ...to carefully register all medications the patient is taking, related or not to RA. 93 5 D 5 ...a very tight control of RA especially when extraarticular manifestations are present, according to what is recommended in key clinical guidelines. 89 3 C 6 ...applying, whenever needed and as soon as possible, preventive measures of osteoporosis and fractures in patients with RA with increased risk of fracture. 93 2 B 7 ...being especially cautious at assessing chronic pain, fatigue, and depression, e.g., ruling out the coexistence of fibromyalgia, at the time of evaluating and deciding a treatment for RA. 89 5 D 8 ...involving the rheumatologist in all phases of planning and decision making of surgical procedures — orthopedic or others — in patients with RA. 89 5 D 9 ...defining the level of responsibility in the management of nonrheumatic comorbidity adjusted to the setting and available resources, and following national or international guidelines for their management. 90 5 D 10 ...routinely promoting health in patients with RA. 89 3 C 11 ...to insist on maintaining an oral hygiene and to follow preventive strategies in case of tooth extraction or dental surgery in patients with RA. 87 5 D 12 ...promoting sexual health and education in patients with RA and their partners, especially concerning issues related to the disease. 79 5 D 13 ...observing evidence-based guidelines for risk management of antirheumatic drugs, especially DMARD — synthetic or biologic — glucocorticoids, and NSAID. 96 5 D 14 ...to inform — and to advise when necessary — regarding the effect of RA and treatments on pregnancy and fertility. 98 5 D 15 ...a periodic individualized assessment of polymedicated patients with RA, weighting the benefits and risks of each medication at each point. 91 5 D 16 ...including the specific management of patients with RA with multimorbidity/polypharmacy in rheumatology training programs, clinical sessions, and research. 89 5 D 17 ...the rheumatologist to be the principal coordinator of integrative care in patients with RA and multimorbidity, independently of the participation and responsibility of other health professionals or specialists. 88 5 D 18 ...establishing good communication, collaboration, and coordination between rheumatology units and other healthcare professionals or providers in the same or other health levels. 95 4 D 19 ...the participation or need of specialized nursing in rheumatology units. 91 5 D 20 ...documenting systematically health outcomes in patients with RA. 87 5 D 21 ...engaging and involving rheumatologists into the development of chronic care models. 92 5 D ↵* Top 10 most important comorbidities are cardiovascular disease, pulmonary disease, cancer, serious infections, smoking, diabetes, amyloidosis, depression and anxiety, obesity, and osteoporosis. %A: agreement degree; LOE: level of evidence; GOR: grade of recommendation; RA: rheumatoid arthritis; DMARD: disease-modifying antirheumatic drugs; NSAID: nonsteroidal antiinflammatory drugs.
