• Kuang-Hui Yu, Hsin-Hua Chen, Tien-Tsai Cheng, Yeong-Jian Jan, Meng-Yu Weng, Yeong-Jang Lin, Hung-An Chen, Jui-Tseng Cheng, Kuang-Yung Huang, Ko-Jen Li, Yu-Jih Su, Pui-Ying Leong, Wen-Chan Tsai, Joung-Liang Lan, and Der-Yuan Chen.
• Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Memorial Hospital, Taoyuan, Taiwan.
• Medicine (Baltimore). 2022 Jan 7; 101 (1): e28501e28501.

BackgroundRheumatoid arthritis (RA)-related comorbidities, including cardiovascular disease (CVD), osteoporosis (OP), and interstitial lung disease (ILD), are sub-optimally managed. RA-related comorbidities affect disease control and lead to impairment in quality of life. We aimed to develop consensus recommendations for managing RA-related comorbidities.MethodsThe consensus statements were formulated based on emerging evidence during a face-to-face meeting of Taiwan rheumatology experts and modified through three-round Delphi exercises. The quality of evidence and strength of recommendation of each statement were graded after a literature review, followed by voting for agreement. Through a review of English-language literature, we focused on the existing evidence of management of RA-related comorbidities.ResultsBased on experts' consensus, eleven recommendations were developed. CVD risk should be assessed in patients at RA diagnosis, once every 5 years, and at changes in DMARDs therapy. Considering the detrimental effects of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids on CVD risks, we recommend using the lowest possible dose of corticosteroids and prescribing NSAIDs cautiously. The OP/fragility fracture risk assessment includes dual-energy X-ray absorptiometry and fracture risk assessment (FRAX) in RA. The FRAX-based approach with intervention threshold is a useful strategy for managing OP. RA-ILD assessment includes risk factors, pulmonary function tests, HRCT imaging and a multidisciplinary decision approach to determine RA-ILD severity. A treat-to-target strategy would limit RA-related comorbidities.ConclusionsThese consensus statements emphasize that adequate control of disease activity and the risk factors are needed for managing RA-related comorbidities, and may provide useful recommendations for rheumatologists on managing RA-related comorbidities.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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