RA Comorbidities: A Short Quiz

ANSWER: The organs most commonly affected by the comorbidities of rheumatoid arthritis (RA) are the eye, heart, lung, and bones. Patients with RA are at increased risk for cardiovascular disease (CVD) events and vasculitis, and CVD accounts for a major part of excess mortality in RA. Other comorbid conditions include chronic obstructive pulmonary disease, interstitial lung disease, uveitis, scleritis, and orthopedic problems including osteoporosis. Risk is also increased for anemia, solid malignancies, infections, and depression.

Source
Aziz M, Yadav KS. Review article - comorbidities in rheumatoid arthritis. J Nurs Care. 2016;5:371. doi:10.4172/2167-1168.1000371.

ANSWER: According to 2015 guidelines from the American College of Rheumatology (ACR), combination disease-modifying antirheumatic drugs (DMARDs), non–tumor necrosis factor (TNF) biologics, or tofacitinib should be used over a TNF inhibitor in patients with RA and established congestive heart failure (CHF). If a TNF inhibitor is needed, the ACR recommends its use only in compensated heart failure. The US FDA has warned against using TNF inhibitors in patients with CHF, based on reports of worsening CHF with TNF inhibitors in the Adverse Event Reporting system database. 

Source
Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2016;68:1-26. doi: 10.1002/art.39480.

ANSWER: Patients with RA are at increased risk for death caused by pulmonary infections. Studies have found that the inactivated influenza vaccine is effective in patients with RA, even in those treated with DMARDs, infliximab, etanercept, or adalimumab-with the exception of rituximab. The European League Against Rheumatism (EULAR) strongly recommends inactivated influenza vaccination in patients with autoimmune inflammatory diseases such as RA.

Source
van Assen S, Agmon-Levin N, Elkayam O, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2011;70:414-422.

ANSWER: Patients with RA are at increased risk for solid tumors and should be screened for cancers of the prostate, breast, uterus, colon, and lung, according to nationally recommended guidelines for age and sex. Screening should also include risk factors for cancer, including family history of inflammatory bowel disease as well as prostate, breast, colon, and skin cancer.

Sources
Aziz M, Yadav KS. Review article - comorbidities in rheumatoid arthritis. J Nurs Care. 2016;5:371. doi:10.4172/2167-1168.1000371.

Roubille C, Richer V, Starnino T, et al. Evidence-based recommendations for the management of comorbidities in rheumatoid arthritis, psoriasis, and psoriatic arthritis: expert opinion of the Canadian Dermatology-Rheumatology Comorbidity Initiative. J Rheumatol. 2015;42:1767-1780. doi: 10.3899/jrheum.141112.

ANSWER: Both methotrexate (MTX) and TNF inhibitors can decrease the risk of CV events in RA, and their use may reduce the need for corticosteroids and NSAIDs. According to recommendations from the Canadian Dermatology-Rheumatology Comorbidity Initiative, the use of corticosteroids should be minimized in patients with RA, particularly those with CV risk factors.

Source
Roubille C, Richer V, Starnino T, et al. Evidence-based recommendations for the management of comorbidities in rheumatoid arthritis, psoriasis, and psoriatic arthritis: expert opinion of the Canadian Dermatology-Rheumatology Comorbidity Initiative. J Rheumatol. 2015;42:1767-1780. doi: 10.3899/jrheum.141112.