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Research ArticleCorrespondence

Extraarticular Manifestations and Comorbidities in Patients With Rheumatoid Arthritis

Pei-Yu Liao, Shin-Liang Liao and Yung-Po Liaw
The Journal of Rheumatology August 2022, 49 (8) 963; DOI: https://doi.org/10.3899/jrheum.211278
Pei-Yu Liao
1School of Medicine, Chung Shan Medical University, Taichung City;
Medical student
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Shin-Liang Liao
2Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City;
MD
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Yung-Po Liaw
3Department of Public Health and Institute of Public Health, and Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, Taiwan.
PhD
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We read with great interest the article by Gunderson et al, which reported the multimorbidity burden in rheumatoid arthritis (RA).1 We appreciate that the authors estimated comorbidities in RA with a novel perspective, thus giving us a chance to further clarify the RA patient complexity. We would like, however, to discuss some key points.

First, in this article,1 rheumatic disease (ie, RA) and its extraarticular manifestations (eg, interstitial lung disease, secondary Sjögren syndrome, vasculitis) were not included as comorbidities. We suggest that the authors take Felty syndrome (FS) into account2 because FS is characterized by the triad of seropositive RA with destructive joint involvement, splenomegaly, and neutropenia. Additionally, normocytic and normochromic anemia are also kinds of FS complications. As deficiency anemia was considered one of the comorbidities discussed in this article, differentiating it from anemias caused by FS can make the analysis clearer.

Second, we suggest that the authors include osteoporosis as one of the comorbidities.3 The glucocorticoid medications often prescribed for the treatment of RA have the possibility of triggering bone loss.4 Moreover, the pain and loss of joint function caused by RA can result in inactivity, further putting patients with RA at risk of osteoporosis.

Third, we recommend collecting the drinking status of patients, if possible. There have been many studies focused on the link between alcohol intake and RA in recent years. Some studies considered moderate drinking as a preventing factor for developing RA,5 while others quantified the hepatotoxic risk of alcohol consumption in patients with RA.6 Adding information on the drinking status of patients can make the association between RA and multimorbidity more thoroughly understood.7

Footnotes

  • PYL and SLL contributed equally to this article.

  • The authors declare no conflicts of interest relevant to this article.

  • Copyright © 2022 by the Journal of Rheumatology

References

  1. 1.↵
    1. Gunderson TM,
    2. Myasoedova E,
    3. Davis JM 3rd,
    4. Crowson CS
    . Multimorbidity burden in rheumatoid arthritis: a population-based cohort study. J Rheumatol 2021;48:1648-54.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Sayah A,
    2. English JC 3rd
    . Rheumatoid arthritis: a review of the cutaneous manifestations. J Am Acad Dermatol 2005;53:191-209.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Dequeker J,
    2. Geusens P
    . Osteoporosis and arthritis. Ann Rheum Dis 1990;49:276-80.
    OpenUrlFREE Full Text
  4. 4.↵
    1. Hanly JG,
    2. Lethbridge L
    . Use of disease-modifying antirheumatic drugs, biologics, and corticosteroids in older patients with rheumatoid arthritis over 20 years. J Rheumatol 2021;48:977-84.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Jin Z,
    2. Xiang C,
    3. Cai Q,
    4. Wei X,
    5. He J
    . Alcohol consumption as a preventive factor for developing rheumatoid arthritis: a dose-response meta-analysis of prospective studies. Ann Rheum Dis 2014;73:1962-7.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Humphreys JH,
    2. Warner A,
    3. Costello R,
    4. Lunt M,
    5. Verstappen SMM,
    6. Dixon WG
    . Quantifying the hepatotoxic risk of alcohol consumption in patients with rheumatoid arthritis taking methotrexate. Ann Rheum Dis 2017;76:1509-14.
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    1. Meer E,
    2. Thrastardottir T,
    3. Wang X, et al
    . Risk factors for diagnosis of psoriatic arthritis, psoriasis, rheumatoid arthritis, and ankylosing spondylitis: a set of parallel case-control studies. J Rheumatol 2022;49:53-9.
    OpenUrlAbstract/FREE Full Text
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Extraarticular Manifestations and Comorbidities in Patients With Rheumatoid Arthritis
Pei-Yu Liao, Shin-Liang Liao, Yung-Po Liaw
The Journal of Rheumatology Aug 2022, 49 (8) 963; DOI: 10.3899/jrheum.211278

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Extraarticular Manifestations and Comorbidities in Patients With Rheumatoid Arthritis
Pei-Yu Liao, Shin-Liang Liao, Yung-Po Liaw
The Journal of Rheumatology Aug 2022, 49 (8) 963; DOI: 10.3899/jrheum.211278
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