Overarching principles and points to consider for reporting or detecting prevalent comorbidities, screening for comorbidity or for risk factors and treatments/vaccination
| Overarching principles | Mean (SD) level of agreement | |
|---|---|---|
| A. Comorbidities such as cardiovascular diseases, malignancies, infections, osteoporosis, peptic ulcer and depression should be carefully assessed and managed in patients with chronic inflammatory rheumatic diseases. | 9.8 (0.5) | |
| B. All clinicians including health professionals such as nurses, treating general practitioners and rheumatologists and patients through self-administered questionnaires and self-management programmes play a key role in the screening and detection of comorbidities. | 9.5 (0.9) | |
| C. Comorbidities should be subject to a systematic, standardised periodical review (eg, at least every 5 years) for those with a chronic inflammatory rheumatic disease. | 9.4 (0.8) | |
| Points to consider | Level of evidence | Mean (SD) level of agreement |
| Cardiovascular diseases | ||
| 1.History of myocardial infarction, pectoris angina, stent, stroke, transient ischaemic attack, heart failure and lower limb peripheral arterial disease should be documented. | 5 | 9.7 (0.5) |
| 2.Cardiovascular risk factors such as smoking status, body mass index, history of hypertension, hypercholesterolaemia, renal insufficiency and HEART-SCORE index should be documented. | 1b | 9.5 (0.9) |
| 3.Current cardiovascular treatments such as antihypertensive therapy, antiplatelet therapy, diabetes insulin or non-insulin therapies, lipid-lowering agents and anticoagulants should be documented. | 5 | 9.6 (0.7) |
| Malignancies | ||
| 4. History of malignancies should be documented. | 5 | 9.6 (0.8) |
| 5. Screening procedures for malignancy (including mammography, pap smear, visit to a dermatologist, faecal occult blood test, colonoscopy) and for malignancy risk factors (including family history of breast or colon cancer and personal history of inflammatory bowel disease) should be documented. | 1b | 8.9 (1.4) |
| Infections | ||
| 6. History of tuberculosis should be documented including prior results of chest X-ray, tuberculin skin test, interferon-γ release assay and BCG vaccination. | 2a | 9.8 (0.5) |
| 7. History of serious infections, opportunistic infections and chronic viral infections should be documented. | 5 | 9.6 (0.5) |
| 8. Vaccination status for infections including influenza, Streptococcus pneumoniae, herpes zoster, human papillomavirus, poliomyelitis, diphtheria, tetanus and hepatitis B should be documented. | 1b | 9.5 (0.7) |
| Peptic ulcer | ||
| 9. History of gastroscopy-proven peptic ulcer should be documented. | 5 | 9.1 (0.9) |
| 10. Risk factors for peptic ulcer such as age >65 years, proton pump inhibitor intake, personal history of complicated ulcer, Helicobacter pylori infection, current use of aspirin, non-steroidal anti-inflammatory drugs, corticosteroids and anticoagulants should be documented | 5 | 9.1 (0.9) |
| Osteoporosis | ||
| 11. History of osteoporotic fracture should be documented. | 5 | 9.5 (0.7) |
| 12. Risk factors for osteoporosis including body mass index <19, physical inactivity, glucocorticoid exposure, alcohol intake, family history of femoral neck fracture, secondary osteoporosis, bone mineral density should be collected and the FRAX global risk should be calculated where applicable. | 2b | 9.0 (1.2) |
| 13. Current or prior osteoporosis treatments including calcium/vitamin D supplementation, bisphosphonates, strontium ranelate, raloxifene, teriparatide and denosumab should be documented. | 5 | 9.5 (0.7) |
| Depression | ||
| 14. History of depression, current depression and prior screening for depression should be documented. | 5 | 9.0 (1.2) |
| 15. Current treatments for depression should be collected. | 5 | 9.2 (0.9) |
BCG, Bacille Calmette Guérin; FRAX, Fracture Risk Assessment Tool.