Rheumatic and musculoskeletal diseases (RMDs) include over 200 diseases that affect over 120 million Europeans of all ages. Aside from the significant direct impact RMDs have on patients, many of them also pose a further significant risk to the population by virtue of accelerating many comorbidities if the RMD is not treated appropriately. The most significant comorbidities of inflammatory RMDs include cardiovascular disease, lung disease, cancers, gastrointestinal disease, and mental health disorders.[1] Many of these comorbidities are prioritised by the EU as key non-communicable diseases (NCDs) addressed by initiatives such as the Beating Cancer Plan and the Healthier Together – EU NCD Initiative. However, this is not the case for RMDs, in part due to the incorrect assumption that they have a low mortality rate.
In fact, patients with RMDs frequently die from the associated comorbidities.[2] RMDs thus comprise a major part of the rapidly increasing emergence of multi-morbidity, whereby people present with more than one chronic illness, each impacting on the treatment and outcome of the other. Unfortunately, when multiple diseases coexist in the same patient, the treatment for the RMD is usually neglected, leading to an even worse quality of life for the complications of reduced physical activity due to pain and the uncontrolled inflammation.[3] Therefore, there is a great need to educate both policymakers and other medical specialties about RMDs and to improve collaboration for better chronic disease care.
The comorbidities of RMDs can be triggered because the underlying conditions are not addressed, often leading to uncontrolled inflammation affecting other organs. As an example:
RMDs increase the risk of heart attack by 63% rising to 98% in lupus patients.[4]
One in five cancers is caused or promoted by inflammation.[5]
People with RMDs live with the consequences of chronic pain daily, so their ability to concentrate at work, exercise or to enjoy life is diminished, affecting their mental health.
The relationship between RMDs, the immune system, inflammation, and comorbidities is complex and multi-dimensional, as exemplified by the abstracts to be presented at the EULAR 2023 Congress in Milan. Additional research is thus needed to address this emergence in multimorbidity.
Optimal treatment of RMDs can help prevent comorbidities. For example, access to effective anti-inflammatory therapies and psychological rehabilitation for people with arthritis may avoid a large psychological burden in Europe.[6] Similarly, access to a rheumatologist and effective anti-inflammatory therapies and rehabilitation for people with RMDs may avoid cardiovascular deaths.[7]
EULAR strongly believes that rheumatology research should therefore stand at the forefront of Europe’s medical arsenal. EULAR calls upon the EU and its member state governments to create a dedicated strategy to combat RMDs. The strategy should focus on improving quality of care (e.g. RMD prevention, early diagnosis, treatment, and rehabilitation), social policy mitigating the burden of RMDs on quality of life and employment (e.g., best practice workplace guidelines, measures to help people with RMDs access, maintain and return to work, funding for societal challenges people with RMDs experience), and research and innovation to develop better RMD prevention and treatment strategies. Rheumatology can provide significant advantages in terms of clinical outcomes and reducing healthcare costs while also helping to ensure the long-term viability of healthcare systems.
Sources
Beydon, M. Does rheumatoid arthritis patients’ risk of overall and site specific cancer differs from the general population ? A national claims database cohort study in the era of biological treatments. Presented at EULAR 2023; abstract OP0044.
Drosos GC, Vedder D, Houben E, et al. EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome. Ann Rheum Dis. 2022 Jun;81(6):768-779
Gopalarathinam R, Arwani M, Wasko MCM, Sharma, TS. Comorbidity in Rheumatic Diseases. In: El Miedany, Y. (eds) Comorbidity in Rheumatic Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-59963-2_1. 2017
Gottenberg, JE. EULAR Points to Consider on the initiation of targeted therapies in patients with inflammatory arthritides and a history of cancer. Presented at EULAR 2023; abstract OP0045.
Ishchenko, A. Higher comorbidity burden in early psoriatic arthritis as compared to early rheumatoid arthritis: clues for pathogenesis of psoriatic disease. Presented at EULAR 2023; abstract OP0066.
Loza E, Jover JA, Rodriguez L, et al. Multimorbidity: prevalence, effect on quality of life and daily functioning, and variation of this effect when one condition is a rheumatic disease. Semin Arthritis Rheum. 2009;38(4):312-9.
Nerurkar L, Siebert S, McInnes IB, Cavanagh J. Rheumatoid arthritis and depression: an inflammatory perspective. Lancet Psychiatry. 2019;6:164-73
Restivo V, Candiloro S, Daidone M, et al. Systematic review and metaanalysis of cardiovascular risk in rheumatological disease: Symptomatic and non-symptomatic events in rheumatoid arthritis and systemic lupus erythematosus. Autoimmun Rev. 2022;21:102925
Saha, P. Lifetime multimorbidity progression in rheumatoid arthritis: a multistate modelling analysis of 20 year data from the Norfolk Arthritis Register. Presented at EULAR 2023; abstract OP0041.
Skielta, M. Does antirheumatic medical treatment of Rheumatoid arthritis affect survival after first acute myocardial infarction. Presented at EULAR 2023; abstract OP0024.
Toledano E, Candelas G, Rosales Z, Martínez Prada C, León L, Abásolo L, Loza E, Carmona L, Tobías A, Jover JÁ. A meta-analysis of mortality in rheumatic diseases. Reumatol Clin. 2012 Nov-Dec;8(6):334-41. doi: 10.1016/j.reuma.2012.05.006. Epub 2012 Jul 11. PMID: 22789463.
Zhou Z, Liu H, Yang Y, et al. The five major autoimmune diseases increase the risk of cancer: epidemiological data from a large-scale cohort study in China. Cancer Commun (Lond). 2022;42:435-46.
About EULAR
EULAR is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with rheumatic and musculoskeletal diseases (RMDs). EULAR aims to reduce the burden of RMDs on individuals and society and to improve the treatment, prevention, and rehabilitation of RMDs. To this end, EULAR fosters excellence in education and research in the field of rheumatology. It promotes the translation of research advances into daily care and fights for the recognition of the needs of people with RMDs by the EU institutions through advocacy action.
Contact
EULAR Communications, communications@eular.org
Notes to Editors
EULAR Recommendations
EULAR School of Rheumatology
EULAR Press Releases
[1] Gopalarathinam, R., Arwani, M., Wasko, M.C.M., Sharma, T.S. (2017). Comorbidity in Rheumatic Diseases. In: El Miedany, Y. (eds) Comorbidity in Rheumatic Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-59963-2_1
[2] Toledano E, Candelas G, Rosales Z, Martínez Prada C, León L, Abásolo L, Loza E, Carmona L, Tobías A, Jover JÁ. A meta-analysis of mortality in rheumatic diseases. Reumatol Clin. 2012 Nov-Dec;8(6):334-41. doi: 10.1016/j.reuma.2012.05.006. Epub 2012 Jul 11. PMID: 22789463.
[3] Loza E, Jover JA, Rodriguez L, et al. Multimorbidity: prevalence, effect on quality of life and daily functioning, and variation of this effect when one condition is a rheumatic disease. Semin Arthritis Rheum. 2009;38(4):312-9.
[4] Restivo V, Candiloro S, Daidone M, et al. Systematic review and metaanalysis of cardiovascular risk in rheumatological disease: Symptomatic and non-symptomatic events in rheumatoid arthritis and systemic lupus erythematosus. Autoimmun Rev. 2022;21:102925
[5] Zhou Z, Liu H, Yang Y, et al. The five major autoimmune diseases increase the risk of cancer: epidemiological data from a large-scale cohort study in China. Cancer Commun (Lond). 2022;42:435-46
[6] Nerurkar L, Siebert S, McInnes IB, Cavanagh J. Rheumatoid arthritis and depression: an inflammatory perspective. Lancet Psychiatry. 2019;6:164-73
[7] Drosos GC, Vedder D, Houben E, et al. EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome. Ann Rheum Dis. 2022 Jun;81(6):768-779
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