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Consensus statement on a framework for the management of comorbidity and extra-articular manifestations in rheumatoid arthritis

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Abstract

The objective of the study was to develop evidence-based and practical recommendations for the detection and management of comorbidity in patients with rheumatoid arthritis (RA) in daily practice. We used a modified RAND/UCLA methodology and systematic review (SR). The process map and specific recommendations, based on the SR, were established in discussion groups. A two round Delphi survey permitted (1) to prioritize the recommendations, (2) to refine them, and (3) to evaluate their agreement by a large group of users. The recommendations cover: (1) which comorbidities should be investigated in clinical practice at the first and following visits (including treatments, risk factors and patient’s features that might interfere with RA management); (2) how and when should comorbidities and risk factors be investigated; (3) how to manage specific comorbidities, related or non-related to RA, including major adverse events of RA treatment, and to promote health (general and musculoskeletal health); and (4) specific recommendations to assure an integral care approach for RA patients with any comorbidity, such as health care models for chronic inflammatory patients, early arthritis units, relationships with primary care, specialized nursing care, and self-management. These recommendations are intended to guide rheumatologists, patients, and other stakeholders, on the early diagnosis and management of comorbidity in RA, in order to improve disease outcomes.

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Acknowledgments

The consensus statement was promoted and funded by the Madrilenian Society of Rheumatology (SORCOM). ROCHE supported the logistics of the meetings and did not intervene in the design, analysis, or editing of the manuscript.

Conflict of interest

Dr. Carmona reports Grants from ROCHE, during the conduct of the study; Grants from MSD, Grants from ABBVIE, Grants from PFIZER, outside the submitted work. Dr. Lajas reports Grants from ROCHE, during the conduct of the study; Grants from MSD, outside the submitted work. Dr. Andreu reports personal fees from ROCHE, during the conduct of the study; personal fees from Abbvie, personal fees from Roche, personal fees from MSD, personal fees from UCB, outside the submitted work. Dr. Balsa reports Grants and personal fees from Roche, during the conduct of the study; Grants and personal fees from Pfizer, Grants and personal fees from Abbvie, personal fees from Roche, personal fees from BMS, personal fees from MSD, personal fees from Novartis, outside the submitted work. Dr. Gonzalez-Alvaro reports Grants and personal fees from Bristol-Myers Squibb, Grants and personal fees from Roche, Grants and personal fees from UCB Pharma, personal fees and other from Abbvie, personal fees and other from Pfizer, other from MSD, outside the submitted work. Dr. Jover reports Grants and personal fees from Roche, during the conduct of the study; Grants and personal fees from Abbvie, Grants from MSD, Grants from Roche, outside the submitted work. Dr. Martinez-Lopez reports Grants from Roche, during the conduct of the study. Dr. Ortiz reports Grants from ROCHE, during the conduct of the study. Dr. Toledano reports Grants from ROCHE, during the conduct of the study.

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Authors and Affiliations

  1. Madrilenian Society of Rheumatology, Madrid, Spain

    Estíbaliz Loza

  2. Rheumatology Unit, Hospital Clínico San Carlos, Madrid, Spain

    Cristina Lajas, Juan Ángel Jover & Esther Toledano

  3. Rheumatology Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

    Jose Luis Andreu

  4. Rheumatology Unit, Hospital Universitario La Paz, Madrid, Spain

    Alejandro Balsa

  5. Rheumatology Unit, Hospital Universitario La Princesa, IIS-Princesa, Madrid, Spain

    Isidoro González-Álvaro, Ana María Ortiz & Santos Castañeda

  6. Rheumatology Unit, Hospital Infanta Sofia, Madrid, Spain

    Oscar Illera

  7. Rheumatology Unit, Hospital Universitario 12 de Octubre, Madrid, Spain

    Isabel Mateo

  8. Rheumatology Unit, Hospital Ramon y Cajal, Madrid, Spain

    Javier Orte

  9. Rheumatology Unit, Instituto Provincial de Rehabilitación, Madrid, Spain

    Javier Rivera

  10. Rheumatology Unit, Hospital Universitario de Getafe, Madrid, Spain

    José Manuel Rodríguez Heredia

  11. Rheumatology Unit, Fundación Jiménez Díaz, Madrid, Spain

    Fredeswinda Romero & Juan Antonio Martínez-López

  12. Rheumatology Unit, Hospital Universitario de Móstoles, Madrid, Spain

    Virginia Villaverde

  13. Instituto de Salud Musculoesquelética, Madrid, Spain

    Loreto Carmona

  14. Servicio de Reumatología, Hospital de la Princesa, Calle Diego de León, 62, 28006, Madrid, Spain

    Santos Castañeda

Authors
  1. Estíbaliz Loza
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  2. Cristina Lajas
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  3. Jose Luis Andreu
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  4. Alejandro Balsa
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  5. Isidoro González-Álvaro
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  6. Oscar Illera
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Corresponding author

Correspondence to Santos Castañeda.

Additional information

Estíbaliz Loza and Cristina Lajas have contributed equally to this work.

On behalf of the GECOAR Study Group.

Electronic supplementary material

Appendix: GECOAR Study Group (in alphabetical order)

Appendix: GECOAR Study Group (in alphabetical order)

Aguado Acín, Pilar; Ahijado Guzmán, Mª del Pilar; Almodóvar González, Raquel; Andreu, José Luis; Aragón Diez, Angel; Bachiller Corral, Javier; Balsa, Alejandro; Barbadillo Mateos, Carmen; Brito Brito, M. Elia; Calvo Aranda, Enrique; Carmona, Loreto; Castañeda, Santos; Crespo Echevarría, Manuel; De Miguel Mendieta, Eugenio; Díaz Oca, Alberto; Garcia de Vicuña, Rosario; García González, Javier; Garcia Vadillo, Alberto; Gonzalez Crespo, Maria Rosa; González Fernández, Carlos; González-Álvaro, Isidoro; Illera, Oscar; Jover, Juan Ángel; Lajas, Cristina; Loza, Estíbaliz; Martínez López, Juan Antonio; Mata Llord, Jose De La; Mateo, Isabel; Morado Quiñoa, Inmaculada C.; Morillas López, Luis; Movasat Hajkhan, Atusa; Mulero Mendoza, Juan; Navío Marco, Maria Teresa; Orte, Javier; Ortiz, Ana María; Revenga Martinez, Marcelino; Rey Rey, José; Richi, Patricia; Rivera, Javier; Rodriguez Heredia, José Manuel; Romero, Fredeswinda; Rosales Rosado, Zulema; Sánchez Sánchez, Marina; Toledano, Esther; Usón, Jacqueline; Valenciano, Ana Cruz; Valero, Marta; Vicente Rabaneda, Esther F.; Villaverde, Virginia.

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Loza, E., Lajas, C., Andreu, J.L. et al. Consensus statement on a framework for the management of comorbidity and extra-articular manifestations in rheumatoid arthritis. Rheumatol Int 35, 445–458 (2015). https://doi.org/10.1007/s00296-014-3196-7

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