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vol. 57

Comorbidities and multimorbidity in rheumatic diseases

Anna Filipowicz-Sosnowska

Reumatologia 2019; 57, 1: 1-2
Online publish date: 2019/02/28
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Recently, the significant negative impact of comorbidities on the course of rheumatoid arthritis (RA) and other inflammatory diseases of the joints has been underlined [1, 2].
A number of comorbidities may have individual impact on the course of rheumatic disease (RD) in individual patients and lead to the limitation of therapeutic options of both diseases. If the co-morbid disease is diagnosed early, properly treated, and monitored, its negative impact on the course of inflammatory RD, e.g. as RA, may be significantly reduced, which is impor­tant for the RD prognosis.
Considering the inflammatory pathophysiological process, the increased risk of diseases, such as: cardiovascular diseases (CVD), lungs and pleura diseases, osteoporosis, infection, depression, and cancers, the incidence of which in RA and other inflammatory RDs is significantly higher than in the general population, should be emphasised. However, the importance of other diseases, such as: diseases of the digestive tract, kidneys, diabetes, and liver diseases, should not be underestimated because they may lead to the deterioration of the patient’s health and reduction of therapeutic options, which requires introduction of comprehensive care for such patients. The reasons for multi-organ involvement in patients with inflammatory joint diseases are not well understood.
It is assumed that the inflammatory process with a release of proinflammatory cytokines and chemokines plays an important role in that phenomenon. Other factors, such as: a reduction of physical activity, in some extreme cases even total immobilisation, obesity, muscle weakness, depression, and pharmacological therapy, mainly with glucocorticosteroids, are considered to be important reasons for the occurrence of diseases other than RD. There is a distinction between coexisting diseases related to RD (and inflammation) or its treatment and diseases independent of the underlying disease (coincidental). Patients with RA and comorbidities constitute the majority in the population of RA patients [3].
Comorbidities are also factors of “poor prognosis” in the course of RA [4]. They also correlate with worse response to treatment, and deterioration of functional capacity and quality of life [4, 5]. Their occurrence increases mortality in RA patients [6]. It is clear that the problem of the coexistence of RD with other diseases is associated with higher socio-economic costs, i.e. more frequent...

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