Despite the availability of several guidelines for the management of RA from international societies and organizations, there is no clear consensus on managing co-morbidities. Significant prevalence in RA-related comorbidities has been noted across the world and guidelines to manage them are required. A systematic review and meta-analysis by Yu et al. have put forth the consensus recommendations for managing RA-related comorbidities. These consensuses underscore the need for adequate control of RA disease activity and the risk factors related to associated comorbidities.
The emerging evidence based on the face-to-face meeting of Taiwan rheumatology experts, modified through three-round Delphi exercises, has been used for developing the consensus statements. Compiling the experts’ consensus, the researchers have arrived at the following key recommendations:
- CVD risk should be assessed in patients at RA diagnosis, once every 5 years, and upon changing DMARDs therapy.
- Considering the detrimental effects of NSAIDs and corticosteroids on CVD risks, the lowest possible dose of corticosteroids and cautious prescription of NSAIDs are recommended
- Osteoporosis/fragility fracture risk assessment should involve dual-energy X-ray absorptiometry and fracture risk assessment (FRAX) in RA.
- The FRAX-based approach with an intervention threshold is ideal for managing osteoporosis.
- RA-ILD assessment includes risk factors, pulmonary function tests, HRCT imaging, and a multidisciplinary decision approach to determine RA-ILD severity.
- A treat-to-target strategy helps in limiting RA-related comorbidities.
The present consensus recommendations are expected to serve as a guide for rheumatologists and general practitioners to offer holistic care to manage and prevent three major comorbidities namely OP/fragility fracture, CVD, and ILD in RA.
Reference: Yu KH, Chen HH, Cheng TT, Jan YJ, Weng MY, Lin YJ, Chen HA, Cheng JT, Huang KY, Li KJ, Su YJ, Leong PY, Tsai WC, Lan JL, Chen DY. Consensus recommendations on managing the selected comorbidities including cardiovascular disease, osteoporosis, and interstitial lung disease in rheumatoid arthritis. Medicine 2022;101:1(e28501).