Case-Based Approach for the Management of Rheumatic Diseases - Episode 11

Comorbidities in Rheumatoid Arthritis

Transcript: Madelaine A. Feldman, MD: Comorbidities with rheumatoid arthritis have become an extremely important topic. As we have looked over the years, in terms of what are the risk factors for cardiovascular disease, we know obesity, high cholesterol, diabetes, smoking, family history, and hypertension all play a part in increasing the risk of cardiovascular disease. We have found the inflammatory burden from rheumatoid arthritis is probably just as important as any of those risk factors for cardiovascular disease. So it is extremely important that we help patients mitigate any of the risk factors that they may have, other than rheumatoid arthritis, in terms of heart disease. For example, optimizing their blood pressure control. Diet and exercise to improve glucose tolerance as well as their weight. If they have high lipids, making sure that either through diet or medication their bad cholesterol comes down. And obviously, if they’re smokers, doing whatever we can to get them to quit smoking. Family history is something that we don’t have any control over, but there are a number of lifestyle modifications and certainly some medications. So controlling the disease activity of the rheumatoid arthritis obviously plays an extremely important role in mitigating the cardiovascular problems that we can see associated with active rheumatoid arthritis.

We’ve gotten pretty good at setting up an algorithm in terms of what medications you use and when, and treat-to-target, and, after 3 months, either changing the medication or advancing the dose. I think one of the things we may have put on the wayside that I think is extremely important in any patient who has a chronic disease is depression. There are many patients who come in for whom we need to make sure that they’re sleeping well and have good social connectedness. All these things can worsen depression. Obviously, the diet, the exercise. Some physicians are recommending some kind of mindfulness or meditative practice. And then, of course, as I suggested, the social connectedness. All those things that go into a healthy lifestyle are probably even more important for our patients with connective tissue diseases and rheumatoid arthritis. For that matter, any of the autoimmune diseases. Because patients can feel isolated. Sometimes helping them deal with that and screening them for depression and actually creating sort of an empathetic bond with your patient, I have found, is worth its weight in gold.

Transcript Edited for Clarity