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J Rheumatol. 2015 Oct;42(10):1767-80. doi: 10.3899/jrheum.141112. Epub 2015 Jul 15.

Evidence-based Recommendations for the Management of Comorbidities in Rheumatoid Arthritis, Psoriasis, and Psoriatic Arthritis: Expert Opinion of the Canadian Dermatology-Rheumatology Comorbidity Initiative.

Author information

1
From the University of Montreal Hospital Research Center (Centre de Recherche du CHUM), Notre-Dame Hospital; Department of Medicine, Dermatology Service, St-Luc Hospital; Sacré-Coeur Hospital of Montreal, University of Montreal; Innovaderm Research; Institut de Rhumatologie de Montréal, Montreal; Centre de Recherche du CHU de Québec, Department of Medicine, Laval University, Quebec City, Quebec; Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, University of Alberta, Edmonton, Alberta; Division of Dermatology, University of Toronto, Toronto; Division of Rheumatology, Western University of Canada, London; Lynde Dermatology, Markham, Ontario; Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.C. Roubille, MD, Rheumatology Research Fellow, University of Montreal Hospital Research Center (Centre de Recherche du CHUM), Notre-Dame Hospital; V. Richer, MD, Dermatology Resident, Department of Medicine, Dermatology Service, St-Luc Hospital; T. Starnino, MD, Rheumatology Resident, Sacré-Coeur Hospital of Montreal, University of Montreal; C. McCourt, MB, BCh, Clinical Fellow in Immunodermatology, Department of Dermatology and Skin Science, University of British Columbia; A. McFarlane, MD, Internal Medicine Resident, Division of Rheumatology, University of Alberta; P. Fleming, MD, Dermatology Resident, Division of Dermatology, University of Toronto; S. Siu, MD, Internal Medicine Resident, Division of Rheumatology, Western University of Canada; J. Kraft, MD, Dermatologist; C. Lynde, MD, Dermatologist, Lynde Dermatology; J. Pope, MD, Professor of Rheumatology, Division of Rheumatology, Western University of Canada; W. Gulliver, MD, Professor of Medicine, Faculty of Medicine, Memorial University of Newfoundland; S. Keeling, MD, Associate Professor of Rheumatology, Division of Rheumatology, University of Alberta; J. Dutz, MD, Professor of Dermatology, Departm

Abstract

OBJECTIVE:

Comorbidities such as cardiovascular diseases (CVD), cancer, osteoporosis, and depression are often underrecognized in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or psoriasis (PsO). Recommendations may improve identification and treatment of comorbidities. The Canadian Dermatology-Rheumatology Comorbidity Initiative reviewed the literature to develop practical evidence-based recommendations for management of comorbidities in patients with RA, PsA, and PsO.

METHODS:

Eight main topics regarding comorbidities in RA, PsA, and PsO were developed. MEDLINE, EMBASE, and the Cochrane Library (1960-12/2012), together with abstracts from major rheumatology and dermatology congresses (2010-2012), were searched for relevant publications. Selected articles were analyzed and metaanalyses performed whenever possible. A meeting including rheumatologists, dermatologists, trainees/fellows, and invited experts was held to develop consensus-based recommendations using a Delphi process with prespecified cutoff agreement. Level of agreement was measured using a 10-point Likert scale (1 = no agreement, 10 = full agreement) and the potential effect of recommendations on daily clinical practice was considered. Grade of recommendation (ranging from A to D) was determined according to the Oxford Centre for Evidence-Based Medicine evidence levels.

RESULTS:

A total of 17,575 articles were identified, of which 407 were reviewed. Recommendations were synthesized into 19 final recommendations ranging mainly from grade C to D, and relating to a large spectrum of comorbidities observed in clinical practice: CVD, obesity, osteoporosis, depression, infections, and cancer. Level of agreement ranged from 80.9% to 95.8%.

CONCLUSION:

These practical evidence-based recommendations can guide management of comorbidities in patients with RA, PsA, and PsO and optimize outcomes.

KEYWORDS:

COMORBIDITY; PSORIASIS; PSORIATIC ARTHRITIS; RHEUMATOID ARTHRITIS

PMID:
26178281
DOI:
10.3899/jrheum.141112
[Indexed for MEDLINE]
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