Comorbidity management in inflammatory rheumatic diseases: a dual-perspective survey of patients and rheumatologists

Abstract

Abstract Background Comorbidities are major contributors to morbidity and mortality in patients with inflammatory rheumatic diseases (IRDs). We assessed real-world implementation of European Alliance of Associations for Rheumatology (EULAR) points to consider for comorbidity management and perceptions of responsibility. Methods We conducted a cross-sectional anonymous online survey among patients with IRDs and rheumatologists in Germany. Two questionnaires assessed demographics, perceived responsibility for comorbidity management, and implementation of preventive measures across five domains: cardiovascular risk, infections, malignancies, depression, and osteoporosis. Responses were analysed using descriptive statistics and group comparisons (chi-square, Fisher’s exact, Mann–Whitney U tests). Results A total of 2,213 patients with IRDs and 140 rheumatologists participated. Patient-reported implementation of comorbidity management in routine care was low across all domains (mean 28.8%). Rheumatologists reported substantially higher implementation than patients across all domains, including blood pressure monitoring (83.6% vs 33.8%) and vaccination checks (77.9% vs 33.2%). Most rheumatologists (69.3%) reported that no structured comorbidity screening was in place. Reported barriers included lack of time (91.4%), unclear responsibilities (48.6%), staff shortages (40.0%), and lack of reimbursement (35.0%). Rheumatologists favoured shared responsibility with general practitioners (GPs) for documentation (61.4%) and screening (48.6%), whereas treatment was more often assigned to GPs alone (60.7%). Patients more frequently assigned primary responsibility to GPs, particularly for cardiovascular risk management (72.6%) and vaccinations (73.8%). Conclusions Comorbidity management in IRDs is poorly implemented in routine care, and perceptions of responsibility differ between patients and rheumatologists. Clearer role definitions, stronger guidance from rheumatology organisations, and practical tools are needed to improve implementation.