Background Patients with Chronic Inflammatory Rheumatic Disorders (CIRDs) frequently present with comorbidities which may be associated with either the rheumatism or its treatment. Recommendations have been developed to deal specifically with some of these comorbidities, in the general population (e.g. lymphoma) or in patients with CIRDs (e.g. vaccinations). However, what is the situation regarding practical recommendations dealing with comorbidities as part of a holistic approach to patients with CIRDs?
Objectives To collect available recommendations dealing with the reporting of already diagnosed comorbidities and the screening for undiagnosed comorbidities or their risk factors, in CIRDs.
Methods A hierarchical systematic literature search was performed in the Medline and Embase databases in December 2014. Inclusion criteria were: recommendations dealing with reporting or screening for 6 comorbidities: 1/ Ischemic heart diseases, 2/ infections, 3/ malignancies, 4/ gastrointestinal (GI) tract diseases, 5/ osteoporosis and 6/ depression. For each comorbidity, we selected specific diseases (e.g. for infections we selected serious infections, tuberculosis (TB), and non-TB opportunistic infections), amounting to a total of 19 diseases. The search was hierarchical: first, international recommendations (ie ACR and/or EULAR) in patients with CIRDs including rheumatoid arthritis, spondyloarthritis, connective tissue disorders and crystal-induced joint diseases; second, if no international recommendation was available in CIRDs, we considered international recommendations for comorbidities in the general population; the third level was national recommendations.
Results A total of 950 abstracts were screened and 48 full-text papers were included. In CIRDs, recommendations for screening the presence of an already diagnosed or undiagnosed comorbidity and /or risk factors were available for only 3 comorbidities totalising 5 diseases: peptic ulcer, myocardial infection, stroke, angina and osteoporosis. Most of the available recommendations for reporting or screening comorbidities were recommendations for the general population. Recommendations were from: ACR and/or EULAR: one comorbidity (5 diseases, 26% total), international recommendations for the general population: 3 comorbidities (9 diseases, 47% total), national recommendations: 2 comorbidities (4 diseases, 21% total). No recommendations were found for 2 comorbidities (3 diseases, 15% total).
Conclusions Recommendations for comorbidity management in CIRDS are scarce. This review is the first step of a EULAR project in order to elaborate points to consider permitting to improve the screening and reporting of comorbidities and their risk factors in CIRDs.
Disclosure of Interest A. Baillet Grant/research support from: Pfizer, UCB, Consultant for: Pfizer, L. Gossec: None declared, L. Carmona: None declared, M. de Wit: None declared, Y. van Eijk-Hustings: None declared, M. Dougados: None declared