Treating rheumatic patients with comorbid conditions: unravelling the complexity

Is it safe to use immunosuppressive drugs to treat a rheumatic patient with a past malignancy? How do rheumatic disease and kidney disease affect each other even when they are unrelated?  How should the increased risk of cardiovascular disease be managed in the treatment of lupus? These are just some of the clinical questions addressed in a new review series, Comorbid conditions in subjects with rheumatic diseases, published in Arthritis Research & Therapy.

Edited by Daniel Aletaha (Medical University of Vienna, Austria) and Thomas Dörner (Charite Humboldt University, Germany), this collection of review articles and accompanying editorial provide a comprehensive update on the challenges of dealing with comorbid conditions in rheumatic diseases, with the aim of facilitating daily decisions in clinical practice. The current lack of clear recommendations on how to manage comorbid scenarios and the difficulty in finding important data from cohort studies and registries were major motivational factors for this series.

One review from Carlo Selmi and colleagues addresses the role of the liver in the clinical management of systemic rheumatic diseases and highlights the need for rheumatologists to be aware of the impact of immunosuppressive agents on underlying viral infections, particularly viral hepatitis.  The effects of immunosuppression were also addressed by oncologist Katarzyna Elandt and rheumatologist Daniel Aletaha in their review on the management of rheumatic patients with a malignant disease.  They propose a detailed algorithm for approaching these clinical scenarios, which includes determining whether the malignancy or its treatment can be attributed as the cause of the rheumatic condition.  Anders and Vielhauer analyse this cause-effect relationship in the context of kidney disease and rheumatic disease and recommend that patients with renal co-morbidity should be managed through close collaboration between a rheumatologist and a nephrologist. 

Other comorbidities covered in this series are cardiovascular disease and pulmonary manifestations of vasculitides. With combined perspectives from expert rheumatologists and specialists from other major fields of medicine, this innovative series makes an exciting and valuable contribution to the medical literature.

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