Comorbidity in rheumatic diseases

Abstract

Comorbidity is a condition that coexists along with the disease of interest. It could be related to the primary disease, its treatment, or be completely independent. Because certain comorbidities occur more frequently in rheumatic diseases, it is likely that the rheumatic diseases and/or their treatments could have a causative role in these comorbidities. Comorbidities such as cardiovascular disease, malignancy, and infection impact the primary rheumatic disease in multiple ways and contribute to a higher mortality. Often they influence the patient's quality of life and prognosis more than the primary disease itself. They add complexity to the management of the primary rheumatic disease and influence therapeutic decisions. While emerging therapies enable tighter control of disease activity, which may reduce certain comorbidities, the new treatments are accompanied by potential risk of toxicity, especially in an aging rheumatic disease population. As care of rheumatic diseases is the focus of the rheumatologist, comorbidities are often managed suboptimally by the rheumatologist in particular and the healthcare team in general. Raising awareness regarding comorbidities among providers and patients, regular screening, tight control of rheumatic disease activity while bearing in mind the risks and benefits of treatment choices, and close collaboration between multiple disciplines including the rheumatologist, primary care physicians, and other specialists could optimize effective management of comorbidities. This introductory chapter is intended to provide a broad overview of the most common and high-impact comorbidities encountered in rheumatic diseases and review some recommendations for their management in clinical practice.