That's not my problem - or is it? Multimorbidity in RA Save

RA can look so easy on the television commercials where patients appear young, healthy, and vibrant on the advertised treatment. 

Dr. Bryant England from University of Nebraska started his talk at RheumNow Live 2025 with these types of promotional images, counseling that this does not match experiences of "real RA." In real-world clinical context, patients are generally more complex with physical and social barriers impacting their care.  According to data from the Veterans Affairs RA Registry and Forward databank, about 75% of patients with RA have multi-morbidity.

Dr. England clarified the differentiation between co-morbidity versus multi-morbidity. The traditional framework of co-morbidity focuses on the disease of RA and the impacts on that disease. Multi-morbidity, by contrast, is patient-centric and focuses on how all diagnoses including rheumatic diseases impact on the patients. He referred to this as a "multi-morbidity web" with the patient feeling trapped in these conditions. The results are impacts on quality of life, physical function, morbidity and mortality. The rheumatoid arthritis is impacted as patients are less likely to be on advanced therapies, have decreased treatment responses, and higher complication rates. 

Dr. England posited that RA patients may benefit from different treatment goals, possibly favoring low disease activity rather than remission to improve function while limiting adverse events.

Multi-morbidity is not just a complication of long-standing RA. Dr. England shows MarketScan US Commercial Claims data demonstrating that RA patients are more likely to have multi-morbidity than the non-RA patients, but that this difference begins years prior to the RA diagnosis. This data suggests that management of multimorbidity in RA should begin early, not wait for later on with disease control.

This lecture concluded on the key question of how rheumatologists should address these issues in conjunction and collaboration with other providers. 

Traditionally, rheumatologists have often been deferential to the non-articular concerns in RA to other providers, though these issues are often left unaddressed. Ideally, the rheumatologist and primary care should have complementary roles. Dr. England notes that PCPs have been more likely to follow lipid and diabetic screening and cancer screening, whereas rheumatologists are more apt to discuss vaccinations, bone health and lifestyle. There is not, however, a "one size fit all" approach and rheumatologists should seek to address issues in CVD, cancer, lung disease, infection, osteoporosis, and mental health as these conditions overlap with rheumatic diseases. Dr. England discussed the "menu" of options to discuss and encouraged RheumNow Live viewers that "doing something is better than nothing."

Dr. Bryant England concludes that all rheumatologists do have a role in the management of multimorbidity in our patients. Even on busy clinic days, give a couple action points to patients to address their overall health and make them healthier individuals to improve overall wellbeing.