Prevalence and pattern of comorbidities in chronic rheumatic and musculoskeletal diseases: the COMORD study

Abstract

increased risk of comorbidities has been reported in Rheumatic and Musculoskeletal Diseases (RMD). We aimed to evaluate the prevalence and pattern of comorbidities in RMD patients nationwide, to identify multimorbidity clusters and to evaluate the gap between recommendations and real screening. Cross-sectional, multicentric nationwide study. Prevalence of comorbidities was calculated according to six EULAR axes. Latent Class Analysis identified multimorbidity clusters. Comorbidities' screening was compared to international and local recommendations. In 769 patients (307 RA, 213 OA, 63 SLE, 103 axSpA, and 83 pSA), the most frequent comorbidities were cardiovascular risk factors and diseases (CVRFD) (hypertension 36.5%, hypercholesterolemia 30.7%, obesity 22.7%, smoking 22.1%, diabetes 10.4%, myocardial infarction 6.6%), osteoporosis (20.7%) and depression (18.1%). Three clusters of multimorbidity were identified: OA, RA and axSpA. The most optimal screening was found for cVRf (> = 93%) and osteoporosis (53%). For malignancies, mammograms were the most optimally prescribed (56%) followed by pap smears (32%) and colonoscopy (21%). Optimal influenza and pneumococcus vaccination were found in 22% and 17%, respectively. Comorbidities were prevalent in RMD and followed specific multimorbidity patterns. Optimal screening was adequate for CVRFD but suboptimal for malignant neoplasms, osteoporosis, and vaccination. The current study identified health priorities, serving as a framework for the implementation of future comorbidity management standardized programs, led by the rheumatologist and coordinated by specialized health care professionals. Rheumatic and musculoskeletal diseases (RMD) are universally prevalent chronic non-communicable diseases (NCD) with a significant contribution to the Global Burden of Diseases 1. They are strong determinants of pain, disability 2-4 and years lived with disability (YLDs) worldwide 5. Many patients experience the concurrent presence of more than one NCD, which is a phenomenon known as multimorbidity 6. NCD may aggregate due to chance-depending on their prevalence in the population-, or due to shared pathophysiologic mechanisms 7,8. They are likely to act synergistically 9 , causing an overall burden that is larger than the sum of their individual impacts. In the general population 6 , four distinct patterns of multimorbidity from chronic NCDs were found: low disease probability, cardio-metabolic conditions, respiratory conditions and RMD and depression pattern, with RMD being highly prevalent across all these patterns. All multimorbidity patterns have a direct association with age and are strongly associated with adverse health outcomes such as long-term disability, frequent healthcare utilization, worsened functional status, poorer quality of life 10 and higher mortality 11,12 .

High Comorbidity Burden in Patients with SLE: Data from the Community-Based Lupus Registry of Crete

“…The multimorbidity state has been well documented in inflammatory arthritides, such as rheumatoid arthritis [ 21 , 83 , 84 , 85 ], whereas fewer reports exist in SLE [ 86 , 87 ]. A remarkable finding in our study was the high prevalence of multimorbidity with more than half of SLE patients reporting ≥3 physical and about one-third of patients reporting ≥2 mental comorbid diseases.…”

Obesity and Morbidity Risk in the U.S. Veteran

“…Of particular concern, the Veteran population may suffer not only from obesity but additional risk factors such as post-traumatic stress disorder (PTSD) [9] and depression [22,23], which may further compound the overall health risk of the individual [24]. The prevalence of obesity among Veterans with PTSD is higher than the prevalence of obesity among Veterans overall within the VHA (47% vs. 41%, respectively) [25].…”

The treatment journey for patients with axial spondyloarthritis in North Africa and the Middle East: From diagnosis to management

“…5 In Lebanon, where the healthcare system is a mix between governmental (completely free) and partial coverage, 47% of patients with axSpA and 33% with peripheral SpA had been treated with bDMARDs. 25 A study of patients with nr-axSpA in North Africa found Ankylosing Spondylitis…”

“…For example, in Qatar, where healthcare is provided free for nationals and at a low cost for residents, one study found that 15% of patients with axSpA were receiving a csDMARD and 40% of patients were receiving a TNF inhibitor 5 . In Lebanon, where the healthcare system is a mix between governmental (completely free) and partial coverage, 47% of patients with axSpA and 33% with peripheral SpA had been treated with bDMARDs 25 . A study of patients with nr‐axSpA in North Africa found Ankylosing Spondylitis Disease Activity Scores and Bath Ankylosing Spondylitis Disease Activity Index scores were suggestive of inadequate disease management 12 .…”