Impact of comorbidity

Patients with rheumatic diseases experience an increased number of comorbidities compared to the general population. Recent advances in disease control have highlighted the impact of comorbidities on all aspects of patient care. Some of the common comorbidities observed in this population include cardiovascular disease, infection, depression, osteoporosis and certain malignancies. This high prevalence has been attributed to chronic inflammation, traditional cardiovascular risk factors, genetics and medications used to treat these conditions. The presence of comorbidity has a major influence on disease outcome, including quality of life, physical function and mortality. In addition, comorbidities add to the complexity of achieving treatment targets and increase the utilisation and cost of care. Despite significant improvements in diagnosing and treating rheumatic diseases, the management of comorbidities remains a challenge. Time constraints in general rheumatology clinics, where the focus is on the index disease, coupled with a lack of disease specific practical guidelines on managing comorbidities, are common barriers to effective management of comorbid conditions in this population. Evaluating outcome measures in both the clinical setting and in research should include the impact of comorbidities which greatly influence the effectiveness of treatment and healthcare costs. Validated screening tools are available and should be incorporated into clinical care, perhaps with a focus in developing more disease specific indices. Rheumatologists have a vital role to play in preventing, detecting and managing comorbidities, as well as coordinating care among other healthcare providers. We propose that the development of care plans encompassing a more holistic approach that incorporates comorbidities, rather than focusing on a single disease-orientated model, will greatly improve overall patient survival and quality of life in rheumatic diseases.