Rheumatology Community Calls for Collaboration to Fight Arthritis Comorbidities
JANUARY 15, 2017
The interaction between rheumatic conditions and cardiovascular risks was a major topic at November’s American College of Rheumatology 2016 Annual Meeting in Washington, DC. Iris Navarro-Milan of the University of Alabama at Birmingham presented her team’s findings that, in over ten thousand rheumatoid arthritis (RA) patients, less than half had ever been screened for hyperlipidemia, a noteworthy cardiovascular risk factor. Her speech addressed a need for greater communication between primary care physicians, rheumatologists, and cardiologists. Though the format of the event was for the press to ask questions of her, she herself levied perhaps the best question: “Who takes ownership of the problem?” Her question was not rhetorical.
Now, the American College of Rheumatology’s Arthritis Care & Research journal has chosen to focus its January issue heavily on the nexus between arthritis and its comorbidities. There’s plenty of studies and articles that reinforce the crossover: one analysis placed cardiovascular and cerebrovascular morbidity risks at 43% and 22% higher, respectively, in patients with psoriatic arthritis than in the general population; another that examined mortality rates in RA patients with breast or prostate cancer (significantly higher than in those without RA); and still another looked into a specially-tailored quit-smoking program for rheumatoid arthritis patients to reduce comorbid burden (there was no significant improvement compared to traditional cessation methods).
In an article underscoring the overall importance of the theme, authors Kristina A. Theis, Teresa J. Brady, and Charles G. Helmick describe how rheumatic illnesses have an “exquisite potential to disrupt the quality of people’s daily lives.” Titled “No One Dies of Old Age Anymore: A Coordinated Approach to Comorbidities and the Rheumatic Diseases”, it contains a litany of alarming statistics about such interactions. They write that half of adults with arthritis have one or more comorbidities, including “high proportions of hypertension (53%), high cholesterol (47%), heart disease (24%), diabetes mellitus (16%), and obesity (36%) that may compromise or complicate recommended management of their arthritis.”
The authors note just how arthritis as a comorbidity can increase risks in other conditions, like obesity, heart disease, and diabetes mellitus: “Arthritis comorbidity is especially problematic for people with these conditions because physical activity is an effective and commonly recommended management approach.” The arthritis won’t kill anyone, but if it makes it more difficult for a person to do exercise that may mitigate their heart disease risk, it just makes that condition more likely to be fatal.
It’s important to acknowledge that arthritis isn’t just a comorbidity for cardiovascular or endocrinal conditions: its aches and pains can just as easily contribute to depression and anxiety, the latter being twice as prevalent in those with arthritis as the former. Half of 20 different disease triads that included arthritis also included anxiety in one study, which also showed that a majority of disease triads associated with depression also included arthritis.
Their review goes on to examine the state of the infrastructure that exists domestically for addressing such comorbidities. “In the US, health care delivery systems have struggled to reorganize to meet the needs of people with chronic diseases and comorbidities,” they write, pointing to the Chronic Care Model as an important resource for restructuring care to better suit patients dealing with a host of conditions.
That model calls for care to be proactive in linking different programs in the healthcare community, and emphasizes the importance of encouraging self-management, which according to the Chronic Care Model website “means more than telling patients what to do. It means acknowledging the patients' central role in their care, one that fosters a sense of responsibility for their own health.”
Their article concludes that “advances in medicine and public health have allowed us to live longer, but we are not necessarily living better due to the burdens of chronic disease and comorbidities.” With improved diagnostics and longer life expectancies, they presume nearly 80 million people in the US alone will be diagnosed with arthritis by 2040, nearly half of whom will experience activity limitations due to the condition. In the meantime, management of comorbidities seems not the sole responsibility of the patient, nor the primary care physician, specialist, or system at large, but rather a combined and concerted effort to be addressed thoughtfully at each of those levels.