‘Disentangling’ disease, treatments and comorbidities can reduce mortality in RMDs
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Managing comorbidities is critical to minimizing deaths in patients with rheumatic and musculoskeletal diseases, according to data presented at EULAR 2023 Congress.
“When you think about RMDs, you basically think about pain and ache,” EULAR Advocacy Chair Loreto Carmona, MD, PhD, a rheumatologist and epidemiologist at the Instituto de Salud Musculoesquelética, in Madrid, Spain, told attendees at a press conference during the meeting. “The problem is they do not come alone. They come with comorbidities related to the complications of the disease and related to underlying risk.”
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The consequences of this are clear, according to Carmona.
“If rheumatologists are not trained to treat all these comorbidities, people would be dying,” she said.
According to EULAR, approximately 200 RMDs impact more than 120 million Europeans “of all ages.”
In addition, patients with RMDs demonstrate a 63% higher risk for heart attack. This risk is elevated as high as 98% among individuals with lupus.
“The most significant comorbidities of inflammatory RMDs include cardiovascular disease, lung disease, cancers, gastrointestinal disease and mental health disorders,” said EULAR in a press release.
Regarding malignancies, EULAR additionally noted that one in five cancers may correlate with inflammation.
Balancing the risks and benefits of therapy in this setting is no easy task, according to Carmona.
“We have inflammation by itself that increases the risk for cancer, so we have to decrease inflammation,” she said. “But we have some therapies that, by the way they work, also increase the risk for cancer. We need to reduce the risk by controlling the disease without increasing the risk with the drugs.”
Although many of these comorbidities have been prioritized by the European Union as important non-communicable diseases, it is necessary to understand that fatalities are possible without appropriate care, Carmona added.
According to EULAR, when multiple diseases coexist in the same patient, the RMD is usually neglected in terms of treatment, leading to an even worse quality of life due to pain, reduced physical activity and uncontrolled inflammation. Therefore, both policymakers and other medical specialties should be educated about RMDs to improve collaboration and improve chronic disease care.
The EULAR conference should serve as an opportunity for that level of education, particularly with certain outcomes that can be more fatal than others, according to Carmona.
“This is a great moment to reflect on the connections between RMDs, cardiovascular disease and mental disease,” she said. “There is interest in rheumatology of disentangling the relationships between treatments, underlying risk for cancer and cardiovascular risk.”
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Carmona L. Rheumatic and musculoskeletal diseases (RMDs) often accelerate lethal comorbidities. Presented at: EULAR 2023 Congress; May 31 to June 3, 2023, Milan, Italy.
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