title: Chronic conditions and health problems in rheumatic diseases: comparisons with rheumatoid arthritis, noninflammatory rheumatic disorders, systemic lupus erythematosus, and fibromyalgia.
abstract: OBJECTIVE
  To describe and compare the prevalence of lifetime and current self-reported comorbidity and associated quality of life in 4 rheumatic diseases, and to investigate comorbid conditions in light of the overlap between the index condition and comorbid conditions (CC), and in the context of symptom-type diagnoses.
  
  
  METHODS
  We studied comorbidity in 11,704 patients with fibromyalgia (FM), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and noninflammatory rheumatic disorders (NIRD). Patients completed semiannual self-reports relating to 22 present and past illnesses and completed the EuroQol (EQ-5D) utility index.
  
  
  RESULTS
  CC were most common in FM, followed by SLE. FM comorbidity was dominated by depression, mental illness, and symptom-type comorbidity (e.g., gastrointestinal and genitourinary disorders). In SLE, there were substantial increases in hypertension, depression, cataract, fractures, and cardiovascular and cerebrovascular, neurologic, lung, gall bladder and endocrine disorders compared with RA. Any current CC reduced the EQ-5D utility by 0.08 to 0.16 units. The lowest EQ-5D score was noted for current psychiatric illness (0.55) and current depression (0.60).
  
  
  CONCLUSIONS
  Four patterns of comorbidity emerged: that associated with aging; that associated with aging but enhanced by the index condition, as in SLE and cardiovascular disease; comorbidity that is part of the symptoms complex of the index condition; and CC that represent lifetime traits or manifestations of the underlying illness. Depression was the most strongly associated correlate of EQ-5D quality of life, and current depression was present in about 15% of patients with RA or NIRD and 34% to 39% of those with SLE and FM.
authors.affiliation: National Data Bank for Rheumatic Diseases, University of Kansas School of Medicine, Wichita, Kansas, USA. fwolfe@arthritis-research.org
authors.forename: Frederick
authors.initials: F
authors.lastname: Wolfe
authors.forename: Kaleb
authors.initials: K
authors.lastname: Michaud
authors.forename: Tracy
authors.initials: T
authors.lastname: Li
authors.forename: Robert S
authors.initials: RS
authors.lastname: Katz
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D012216:Rheumatic Diseases / Q000453:epidemiology*; D011795:Surveys and Questionnaires