Consensus statement on a framework for the management of comorbidity and extra-articular manifestations in rheumatoid arthritis

Abstract

The objective of the study was to develop evidence-based and practical recommendations for the detection and management of comorbidity in patients with rheumatoid arthritis (RA) in daily practice. We used a modified RAND/UCLA methodology and systematic review (SR). The process map and specific recommendations, based on the SR, were established in discussion groups. A two round Delphi survey permitted (1) to prioritize the recommendations, (2) to refine them, and (3) to evaluate their agreement by a large group of users. The recommendations cover: (1) which comorbidities should be investigated in clinical practice at the first and following visits (including treatments, risk factors and patient's features that might interfere with RA management); (2) how and when should comorbidities and risk factors be investigated; (3) how to manage specific comorbidities, related or non-related to RA, including major adverse events of RA treatment, and to promote health (general and musculoskeletal health); and (4) specific recommendations to assure an integral care approach for RA patients with any comorbidity, such as health care models for chronic inflammatory patients, early arthritis units, relationships with primary care, specialized nursing care, and self-management. These recommendations are intended to guide rheumatologists, patients, and other stakeholders, on the early diagnosis and management of comorbidity in RA, in order to improve disease outcomes.

Fibromyalgia is associated to receiving chronic medications beyond appropriateness: a cross-sectional study

“…For example, in rheumatoid arthritis the extra-articular manifestations are considered as clinical manifestations by some authors or as comorbidities by others [19]. The treatment used to be almost the same.…”

Consensus Statement on the Management of Comorbidity in Patients with Rheumatoid Arthritis and Psoriasis

“…As in the Spanish recommendations (Table 1), most of the 19 recommendations from the Canadian Initiative received a grade C/D from the Oxford Centre for Evidence-based Medicine, with a level of agreement > 80% in all of them 1,2 . The overall assessment of the recommendations, according to the Centre for Evidence-based Medicine, is low (C/D, with A the highest and D the lowest) because they are based on expert opinion, although their influence is strong, which can be inferred by their wide applicability to clinical practice.…”

Development of a Canadian Core Clinical Dataset to Support High-quality Care for Canadian Patients with Rheumatoid Arthritis

“…• Comorbidities: The list of comorbidities was refined during this phase based on a consensus statement 34 and evidence-based recommendations 35 for the management of comorbidities in RA. The 10 categories, including important subcategories, were suggested for inclusion (Table 3).…”