Background RA co-morbidities are not well understood by policymakers. The National Rheumatoid Arthritis Society (NRAS) wants to ensure better recognition to improve overall care. A literature review was undertaken to identify the RA-comorbidities and policies affecting patient care.

Objectives The research aims to identify co-morbidities affecting RA patients, analyse associated risks and appraise whether existing policies promote effective management and treatment.

Methods A literature review was undertaken to identify co-morbidites, which was shared with NRAS medical advisers for approval.

Six one-hour telephone interviews were conducted with NRAS members. The results were transcribed as case studies for the report.

A second literature review was conducted to identify policies in England affecting treatment and management. Evidence was then sought on implementation of these policies.

Results The average RA patient has 1.6 co-morbidities and the number of co-morbidities increases with age. Around 80 per cent of RA patients have one or more co-morbidities. There are around 464,000 RA patients in England that live with a co-morbidity¹.

RA patients are at risk of developing co-morbidities relating to cardiovascular health, lung disease, bone disease, different cancers, and depression.

The risk of heart attack is double for RA patients², atrial fibrillation risk is around 40 per cent higher³, and the risk of stroke is also 30 per cent higher⁴. Interstitial lung disease is a major cause of death⁵ and rates of osteoporosis are up to twice as high than the general population⁶. Depression is also raised amongst RA patients⁷.

The policy review found an implementation gap. Successive governments have promoted access to the multidisciplinary team, provision of care plans, holistic annual reviews, and self-management as strategies to manage and treat co-morbidities. However, NRAS uncovered evidence of poor implementation.

Conclusions Strategies by successive governments to improve treatment and management of RA co-morbidities have not been co-ordinated or effectively implemented.

To improve care, providers need to implement recommendations in NICE clinical guideline 79 on RA. Appropriate statements on care planning need to be included in the NICE RA quality standard and in the Quality and Outcomes Framework. The Information Prescription for patients needs to be improved and a musculoskeletal strategic clinical network should be created to promote a co-ordinated approach.

1. Parodi M et al, ‘Co-morbidities in rheumatoid arthritis: analysis of hospital discharge records’, Rheumatism, 2005, 57(3): 154-603

2. Solomon et al, ‘Patterns of cardiovascular risk in rheumatoid arthritis,’ Annals of the Rheumatic Diseases’, 2006; 65(12), 1608-16124

3. Lindhardsen J et al, ‘Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study’, British Medical Journal, 2012; 3445

4. Lindhardsen J et al, ‘Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study’, British Medical Journal, 2012; 3446

5. Michaud K, ‘Co-morbidities in rheumatoid arthritis’, Clinical Rheumatology, 2007; 21, 885-9067

6. CKS Clinical Knowledge Summaries, Rheumatoid Arthritis – management, accessed 1 May 2012 via: http://www.cks.nhs.uk/rheumatoid_arthritis/management/scenario_confirmed_ra/role_of_primary_care/complications_and_comorbidities

7. Michaud K, ‘Co-morbidities in rheumatoid arthritis’, Clinical Rheumatology, 2007; 21, 885-9068.

Acknowledgements The drafting of this report was supported by Roche Products Ltd and Chugai Pharma UK Ltd. Editorial control rests with NRAS.

Disclosure of Interest None Declared