Comorbidity and Arthritis: A Growing Concern

Comorbidities May Affect How Arthritis Is Treated

Rheumatoid arthritis, general practitioner examining patient and hand for signs of rheumatoid arthri
ADAM GAULT/SPL Getty

The words "comorbidity" and "comorbid condition" are common medical terms. A comorbidity refers to one or more diseases or conditions that occur along with another condition in the same person at the same time.

Conditions considered comorbidities are often long-term or chronic conditions. Other terms that are used interchangeably with comorbidity include coexisting conditions, co-occurring conditions, multimorbidity, or multiple chronic conditions.

Comorbidity and Arthritis

Using rheumatoid arthritis as an example, there are comorbidities associated with the disease which are nonarticular manifestations. These are conditions that affect body parts other than joints. These tend to occur with higher frequency than would be expected in the normal population. 

These include conditions such as subcutaneous rheumatoid nodules, vasculitis, neuritis, Sjogren's syndrome and Felty's syndrome. Although these conditions are not found in all people with rheumatoid arthritis, when present, they may influence treatment.

Comorbid conditions can also include diseases and conditions other than rheumatic conditions. It can refer to arthritis together with diabetes, heart disease, or cancer as well. Comorbidities may lead to the development of anxiety and depression as people face multiple treatments and growing costs associated with it.

Comorbidity Statistics

According to the Centers for Disease Control and Prevention (CDC), nearly half of adults in the United States with arthritis also have at least one other chronic condition.

While heart disease is the most common, diabetes, obesity, high cholesterol, and chronic respiratory conditions are high on the list as well.

The CDC revealed that in the United States:

  • 49 percent of adults with heart disease also had arthritis.
  • 47 percent of adults with diabetes also had arthritis.
  • 31 percent of adults who are obese have arthritis.

    Why Is Comorbidity Common With Arthritis?

    There is no concrete answer regarding why it is common for people with arthritis to have comorbidities. Speculation has pointed to non-modifiable risk factors as well as modifiable risk factors that are associated with arthritis and the comorbidities. In other words, they have things in common.

    Age is an example of a non-modifiable risk factor that would be common with most comorbidities. Obesity and smoking are examples of the shared modifiable risk factors. The CDC has emphasized the importance of remaining physically active to help arthritis as well as the comorbidity. 

    Despite the emphasis on remaining active:

    • 1 in 5 people is physically inactive with heart disease or diabetes alone.
    • 1 in 3 people is physically inactive with either heart disease or diabetes and arthritis comorbidity.

    Arthritis clearly adds to the burden of managing these other conditions.

    General Consequences of Comorbidity

    Generally, comorbidity is tied to worsening health outcomes, the need for more complex treatment and disease management, and higher health care costs.

    It's not unusual to be faced with managing multiple chronic conditions. Reportedly, nearly 77 percent of Medicare spending goes to people with two or more chronic conditions.

    Medicare beneficiaries with five or more conditions make up only 11 percent, but the cost is nearly 41 percent of expenditures.

    Another point that researchers have considered, with regard to comorbidity, is the chronology of the conditions. It may be significant which disease occurred first. For example, knowing whether arthritis or depression developed first may have implications regarding disease onset, prognosis, and treatment.

    When selecting from treatment options for comorbidities, it is also important to recognize and steer clear of treatments that are antagonistic. Using a particular treatment for one condition may further complicate the other.

    What You Can Do

    Researchers are increasingly concerned over the rise in comorbidity among people with arthritis. As the U.S. population ages, they are looking at ways to mitigate the effects of treating multiple chronic conditions.

    Treatments for multiple conditions can include conflicting medical advice, increased cost, and duplicative tests or adverse medication effects. The medical community is recognizing this and many doctors are working on a more patient-centered approach.

    If you have other conditions along with arthritis, speak to your doctor and healthcare team about ways to address the problems you face. Increasing physical activity, coordinating doctor appointments and tests, and properly managing medications are just a few of the suggestions. 

    Every case is different and although some people prioritize their various health conditions, this is not the best idea. It's recommended that you work with your doctors to devise a healthcare plan that addresses your entire health. This can lead to a higher quality of life.

    Sources:

    Centers for Disease Control and Prevention. Comorbidities. Data and Statistics. Arthritis. 2017.

    MaCurdy , Bhttacharya J. Challenges in Controlling Medicare Spending: Treating Highly Complex Patients. Acumen, LLC/Centers for Medicare and Medicaid Services. 2014.

    Theis KA, Brady TJ, Helmick CG. No One Dies of Old Age Anymore: A Coordinated Approach to Comorbidities and the Rheumatic Diseases. Arthritis Care and Research. 2017;69(1):1-4.

    Valderas JM, et al. Defining Comorbidity: Implications for Understanding Health and Health Services. Annals of Family Medicine. 2009 Jul; 7(4): 357–363. doi: 10.1370/afm.983

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