Table 2

Overarching principles and points to consider for reporting or detecting prevalent comorbidities, screening for comorbidity or for risk factors and treatments/vaccination

 Overarching principlesMean (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 considerLevel of evidenceMean (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.

59.7 (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.

1b9.5 (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.

59.6 (0.7)
4. History of malignancies should be documented.59.6 (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.1b8.9 (1.4)
6. History of tuberculosis should be documented including prior results of chest X-ray, tuberculin skin test, interferon-γ release assay and BCG vaccination.2a9.8 (0.5)
7. History of serious infections, opportunistic infections and chronic viral infections should be documented.59.6 (0.5)
8. Vaccination status for infections including influenza, Streptococcus pneumoniae, herpes zoster, human papillomavirus, poliomyelitis, diphtheria, tetanus and hepatitis B should be documented.1b9.5 (0.7)
Peptic ulcer
9. History of gastroscopy-proven peptic ulcer should be documented.59.1 (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 documented59.1 (0.9)
11. History of osteoporotic fracture should be documented.59.5 (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.2b9.0 (1.2)
13. Current or prior osteoporosis treatments including calcium/vitamin D supplementation, bisphosphonates, strontium ranelate, raloxifene, teriparatide and denosumab should be documented.59.5 (0.7)
14. History of depression, current depression and prior screening for depression should be documented.59.0 (1.2)
15. Current treatments for depression should be collected.59.2 (0.9)
  • BCG, Bacille Calmette Guérin; FRAX, Fracture Risk Assessment Tool.