Department of Rheumatology, Colchester General Hospital, Colchester, UK.
Centre for Rheumatic Diseases, King's College London, London, UK.
Rheumatology (Oxford). 2023 Oct 23;62(SI3):SI260-SI270. doi: 10.1093/rheumatology/kead489.
Early identification and management of multimorbidity in patients with rheumatic and musculoskeletal diseases (RMDs), such as RA, is an integral, but often neglected, aspect of care. The prevalence and incidence of conditions such as osteoporosis, cardiovascular disease, pulmonary disease and malignancies, often co-existing with RA, continues to have significant implications for the management of this patient group. Multimorbidity in RMDs can be associated with inflammatory disease activity and target organ damage. Lifestyle factors, such as smoking and inactivity, further contribute to the burden of disease. Inflammation is the underlying factor, not just in RA but also many comorbidities. The current framework of a treat-to-target approach focuses on achieving early remission and inflammatory activity suppression. We describe how the comorbidity burden in people with RMDs impacts on disease outcome and treatment response. The importance of addressing comorbidity at an early stage and adopting a patient centred approach is critical in modern practice.
早期识别和管理风湿和肌肉骨骼疾病（RMDs）患者的多种合并症，如类风湿关节炎（RA），是治疗的一个重要但经常被忽视的方面。骨质疏松症、心血管疾病、肺部疾病和恶性肿瘤等与 RA 同时存在的疾病的患病率和发病率，继续对该患者群体的管理产生重大影响。RMDs 中的多种合并症可能与炎症性疾病活动和靶器官损伤有关。生活方式因素，如吸烟和不活动，进一步加重了疾病负担。炎症是一个根本因素，不仅在 RA 中，在许多合并症中也是如此。目前的治疗目标方法框架侧重于实现早期缓解和炎症活动抑制。我们描述了 RMDs 患者的合并症负担如何影响疾病结局和治疗反应。在现代实践中，早期解决合并症并采取以患者为中心的方法至关重要。
