Over the past several decades it has become clear that many rheumatologic conditions are complicated by a number of comorbidities. Comorbidities are distinct from extra-articular features of a rheumatologic disorder. These are other conditions that occur in individuals with either inflammatory or non-inflammatory rheumatologic disorders, but are not directly related to the underlying condition.
Many rheumatology patients have co-existent diabetes. This is particular true among patients with psoriatic arthritis (PsA). Recent data demonstrate that diabetes occurs with higher prevalence among PsA patients, and its prevalence has increased over the past few decades. Another important comorbidity is cardiovascular disease. Cardiovascular disease occurs more commonly among patients with rheumatoid arthritis, systemic lupus erythematosus, PsA and ankylosing spondylitis, than in the general population. Moreover, cardiovascular events occur at an earlier age in patients with these inflammatory conditions. Hypertension also occurs more frequently among patients with rheumatologic conditions, partly related to the therapy provided. In each of these conditions it seems that the underlying inflammatory condition predisposes to the comorbidity, and in several studies the degree of inflammation is related to both the frequency and severity of the underlying disease. More recently it has become clear that the metabolic syndrome which incorporates obesity, diabetes, hyperlipidemia, and hypertension is increase among patients with PsA, AS and SLE, thus predisposing them to cardiovascular disease.
Another comorbidity which affects patients with rheumatologic disorders is depression. This is particularly noticeable among patients with PsA, who also suffer from psoriasis, a condition also known to be associated with depression. The depression may also be related to the inflammatory burden of both skin and joint disease.
The management of these comorbidities requires firstly screening for them. Studies have shown that we do not do a good job screening for and treating hypertension, hyperglycemia and hyperlipidemia in rheumatology patients. One issue to consider is who should be doing this, is it the rheumatologist or the family physician, and how it should be done.
Disclosure of Interest None declared