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Review
. 2021 Feb 1;10(3):509.
doi: 10.3390/jcm10030509.

The Key Comorbidities in Patients with Rheumatoid Arthritis: A Narrative Review

Peter C Taylor  1 , Fabiola Atzeni  2 , Alejandro Balsa  3 , Laure Gossec  4   5 , Ulf Müller-Ladner  6 , Janet Pope  7
Affiliations
Review

The Key Comorbidities in Patients with Rheumatoid Arthritis: A Narrative Review

Peter C Taylor et al. J Clin Med. .

Abstract

Comorbidities in patients with rheumatoid arthritis (RA) are often associated with poor health outcomes and increased mortality. Treatment decisions should take into account these comorbidities due to known or suspected associations with certain drug classes. In clinical practice, it is critical to balance potential treatment benefit against the possible risks for comorbidities as well as the articular manifestations of RA. This review summarises the current literature relating to prevalence and risk factors for the important comorbidities of cardiovascular disease, infections, lymphomas and nonmelanoma skin cancers in patients with RA. The impact on patient outcomes and the interplay between these comorbidities and the therapeutic options currently available, including tumour necrosis factor inhibitors and newer biological therapies, are also explored. As newer RA therapies are developed, and patients gain wider and earlier access to advanced therapies, in part due to the emergence of biosimilars, it is important to consider the prevention or treatment of comorbidities as part of the overall management of RA.

Keywords: cardiovascular disease; comorbidities; extra-articular manifestations; infections; lymphoma; nonmelanoma skin cancers; rheumatoid arthritis; tumour necrosis factor.

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Conflict of interest statement

The sponsor (Fresenius Kabi SwissBioSim GmbH) provided funding for medical writing support and a formal review of the publication, but the authors had final authority, including the choice of journal. P.C.T. has received research grants from Celgene, Galapagos, Gilead and Lilly and consultation fees from AbbVie, Biogen, BMS, Fresenius Kabi SwissBioSim GmbH, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Nordic Pharma, Pfizer, Roche, Sanofi and UCB. F.A. has received research grants from BMS, Celgene, Novartis and Sandoz and consulting and travel fees from AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer and Sanofi-Aventis. A.B. has served as a speaker or consultant for, and received research grants from, AbbVie, Amgen, BMS, Galapagos, Gilead, Lilly, Nordic, Novartis, Pfizer, Roche, Sandoz and UCB. L.G. has received research grants from Amgen, Galapagos, Janssen, Lilly, Pfizer, Sandoz and Sanofi and consultation fees from AbbVie, Amgen, Biogen, BMS, Celgene, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis and UCB. U.M.L. has served as a speaker, consultant or advisory member for AbbVie, Amgen, Biogen, BMS, Boehringer, Chugai, Gilead, Janssen, Lilly, Medac, MSD, Roche and Sanofi. J.P. has received research grants from Bayer, BMS, Gilead, Merck, Roche, Seattle Genetics and UCB and has served as a speaker, consultant and/or advisory member for AbbVie, Amgen, BI, BMS, EMERALD, Eicos Sciences, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB.

Figures

Figure 1
Figure 1
Chronic inflammation in rheumatoid arthritis as a risk factor for cardiovascular disease. The proinflammatory mechanisms underlying RA may contribute to the development of atherosclerosis [45,46,47], promotion of cardiac remodelling [48], alterations in lipid blood profiles [49] and changes to the morphology of red blood cells [50]. RA can be exacerbated by cytomegalovirus infection and is linked to coronary artery damage via cytotoxic T-cells [51]. The autoimmune mechanisms that drive RA have been linked to abnormal fibrin clot formation and increased CVD risk; however, the extent to which this is affected in RA remains unclear [52]. Grey bar indicates nonlocalised effects. Abbreviations: CVD, cardiovascular disease; HDL, high-density lipoprotein; RA, rheumatoid arthritis.
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References

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