title: Collection and management of selected comorbidities and their risk factors in chronic inflammatory rheumatic diseases in daily practice in France.
abstract: BACKGROUND
  In chronic inflammatory rheumatic diseases (CIRDs), comorbidities such as cardiovascular disease and infections are sub-optimally managed. EULAR recently developed points to consider to collect and report comorbidities. The objective of this present study was to develop a pragmatic guide to collect, report and propose management recommendations for comorbidities, from a rheumatologist perspective.
  
  
  METHODS
  The collection and reporting of comorbidities and risk factors was adapted from the EULAR points to consider. To develop management recommendations, the process comprised (1) systematic literature reviews by 3 fellows and (2) a 2-day consensus process involving 110 experts (rheumatologists and health professionals). Votes of agreement (Likert 1-5 where 5 indicates full agreement) were obtained.
  
  
  RESULTS
  The six selected comorbidities were ischemic cardiovascular diseases, malignancies, infections, diverticulitis, osteoporosis and depression. The literature review retrieved 97 articles or websites, mostly developed for the general population. The consensus process led to reporting presence of comorbidities, current treatment, risk factors (e.g. hypertension), screening (e.g. mammography) and prevention (e.g. vaccination). Management recommendations include physical examination (e.g. blood pressure or lymph node examination), prescribing screening procedures, and interpreting results to refer in a timely manner to appropriate other health professionals. Agreement was high (mean±standard deviation, 4.37±0.33).
  
  
  CONCLUSIONS
  Using an evidence-based approach followed by expert consensus, this initiative furthers the dissemination in France of the EULAR points to consider, and clearly defines what part of the management of comorbidities is potentially within the remit of rheumatologists. This initiative should facilitate systematic management of patients with CIRDs.
authors.affiliation: Institut Pierre-Louis d'épidémiologie et de Santé publique, GRC-UPMC 08 (EEMOIS), Sorbonne universités, UPMC université Paris 06, 75006 Paris, France; Department of rheumatology, Pitié-Salpêtrière hospital, AP-HP, 75013 Paris, France. Electronic address: laure.gossec@aphp.fr.
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
authors.affiliation: GREPI-CNRS, université Joseph-Fourier, 38185 Grenoble, France; Department of rheumatology, Grenoble hospital, 38185 Grenoble, France.
authors.forename: Athan
authors.initials: A
authors.lastname: Baillet
authors.affiliation: Department of rheumatology, Pitié-Salpêtrière hospital, AP-HP, 75013 Paris, France.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Dadoun
authors.affiliation: Department of rheumatology, UMR5535 CNRS, CHU de Montpellier, 34295 Montpellier, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Daien
authors.affiliation: UMRS 938, DHU i2B, UPMC université Paris 06, Sorbonne university, 75006 Paris, France; Department of rheumatology, Saint-Antoine hospital, AP-HP, 75012 Paris, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Berenbaum
authors.affiliation: Department of rheumatology, Le Mans hospital, 72037 Le Mans, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Dernis
authors.affiliation: Department of rheumatology, Gabriel-Montpied university hospital, 63113 Clermont-Ferrand, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Fayet
authors.affiliation: Department of rheumatology, Cochin hospital, AP-HP, 75014 Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Hudry
authors.affiliation: Department of rheumatology, Cochin hospital, AP-HP, 75014 Paris, France.
authors.forename: Maryse
authors.initials: M
authors.lastname: Mezieres
authors.affiliation: Department of rheumatology, hôpitaux de Rouen, 76031 Rouen, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Pouplin
authors.affiliation: Department of rheumatology, Pellegrin hospital, 33063 Bordeaux, France; Bordeaux university, 33063 Bordeaux, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Richez
authors.affiliation: Department of rheumatology, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29019 Brest, France; EA 2216, Inserm ESPRI, ERI29, université Bretagne Occidentale, 29019 Brest, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.affiliation: Department of rheumatology, Gabriel-Montpied university hospital, 63113 Clermont-Ferrand, France.
authors.forename: Carine
authors.initials: C
authors.lastname: Savel
authors.affiliation: Rheumatology department, Sainte Marguerite hospital, AP-HM, 13000 Marseille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Senbel
authors.affiliation: Department of rheumatology, Gabriel-Montpied university hospital, 63113 Clermont-Ferrand, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Soubrier
authors.affiliation: Hospital center of Mulhouse, 68224 Mulhouse, France.
authors.forename: Laëtitia
authors.initials: L
authors.lastname: Sparsa
authors.affiliation: Department of rheumatology, CHRU de Besançon, 25056 Besançon, France; EA 4266, université de Franche-Comté, 25056 Besançon, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
authors.affiliation: Department of rheumatology, Cochin hospital, AP-HP, 75014 Paris, France; Paris Descartes university, 75006 Paris, France; Inserm (U1153) clinicalepidemiology and biostatistics, PRES Sorbonne Paris-Cité, 75006 Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
mesh_terms: D002908:Chronic Disease; D015897:Comorbidity; D032921:Consensus; D005602:France / Q000453:epidemiology; D006801:Humans; D017410:Practice Guidelines as Topic; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012219:Rheumatology / Q000592:standards; D012307:Risk Factors
keywords: Comorbidities; Management; Rheumatoid arthritis; Spondyloarthritis