title: Consensus statement on a framework for the management of comorbidity and extra-articular manifestations in rheumatoid arthritis.
abstract: The objective of the study was to develop evidence-based and practical recommendations for the detection and management of comorbidity in patients with rheumatoid arthritis (RA) in daily practice. We used a modified RAND/UCLA methodology and systematic review (SR). The process map and specific recommendations, based on the SR, were established in discussion groups. A two round Delphi survey permitted (1) to prioritize the recommendations, (2) to refine them, and (3) to evaluate their agreement by a large group of users. The recommendations cover: (1) which comorbidities should be investigated in clinical practice at the first and following visits (including treatments, risk factors and patient's features that might interfere with RA management); (2) how and when should comorbidities and risk factors be investigated; (3) how to manage specific comorbidities, related or non-related to RA, including major adverse events of RA treatment, and to promote health (general and musculoskeletal health); and (4) specific recommendations to assure an integral care approach for RA patients with any comorbidity, such as health care models for chronic inflammatory patients, early arthritis units, relationships with primary care, specialized nursing care, and self-management. These recommendations are intended to guide rheumatologists, patients, and other stakeholders, on the early diagnosis and management of comorbidity in RA, in order to improve disease outcomes.
authors.affiliation: Madrilenian Society of Rheumatology, Madrid, Spain.
authors.forename: Estíbaliz
authors.initials: E
authors.lastname: Loza
authors.forename: Cristina
authors.initials: C
authors.lastname: Lajas
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Andreu
authors.forename: Alejandro
authors.initials: A
authors.lastname: Balsa
authors.forename: Isidoro
authors.initials: I
authors.lastname: González-Álvaro
authors.forename: Oscar
authors.initials: O
authors.lastname: Illera
authors.forename: Juan Ángel
authors.initials: JÁ
authors.lastname: Jover
authors.forename: Isabel
authors.initials: I
authors.lastname: Mateo
authors.forename: Javier
authors.initials: J
authors.lastname: Orte
authors.forename: Javier
authors.initials: J
authors.lastname: Rivera
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Rodríguez Heredia
authors.forename: Fredeswinda
authors.initials: F
authors.lastname: Romero
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Martínez-López
authors.forename: Ana María
authors.initials: AM
authors.lastname: Ortiz
authors.forename: Esther
authors.initials: E
authors.lastname: Toledano
authors.forename: Virginia
authors.initials: V
authors.lastname: Villaverde
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
authors.forename: Santos
authors.initials: S
authors.lastname: Castañeda
mesh_terms: D000686:Amyloidosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000628:therapy; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D003697:Delphi Technique; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D019468:Disease Management; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008171:Lung Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D010024:Osteoporosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012219:Rheumatology / Q000592:standards; D012907:Smoking / Q000453:epidemiology / Q000628:therapy