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

Patient-reported implementation of comorbidity management in routine care was low across all five domains studied.

• The cross-sectional anonymous online survey in Germany included 2,213 patients with IRDs and 140 rheumatologists.
• Mean patient-reported implementation across domains was 28.8%.
• Domains assessed were cardiovascular risk, infections, malignancies, depression, and osteoporosis, based on EULAR points to consider.

Rheumatologists reported substantially higher implementation of comorbidity management than patients did, in all domains.

• Blood pressure monitoring was reported by 83.6% of rheumatologists vs 33.8% of patients.
• Vaccination checks were reported by 77.9% of rheumatologists vs 33.2% of patients.
• Group comparisons used chi-square, Fisher's exact, and Mann-Whitney U tests.

Most rheumatologists reported that no structured comorbidity screening was in place in their practice.

• 69.3% of rheumatologists reported no structured comorbidity screening.
• This was based on responses from 140 rheumatologists in Germany.

Rheumatologists reported multiple barriers to comorbidity management, most commonly lack of time.

• Lack of time was reported by 91.4%.
• Unclear responsibilities were reported by 48.6%.
• Staff shortages were reported by 40.0%.
• Lack of reimbursement was reported by 35.0%.

Rheumatologists favoured shared responsibility with GPs for documentation and screening, but assigned treatment more often to GPs alone.

• Shared responsibility with GPs was favoured for documentation by 61.4%.
• Shared responsibility with GPs was favoured for screening by 48.6%.
• Treatment was assigned to GPs alone by 60.7% of rheumatologists.

Patients more frequently assigned primary responsibility for comorbidity management to GPs, particularly for cardiovascular risk and vaccinations.

• 72.6% of patients assigned primary responsibility for cardiovascular risk management to GPs.
• 73.8% of patients assigned primary responsibility for vaccinations to GPs.
• Perceptions of responsibility differed between patients and rheumatologists.

The authors conclude that clearer role definitions, stronger guidance from rheumatology organisations, and practical tools are needed to improve implementation of comorbidity management.

• Conclusion is based on low implementation, reported barriers, and divergent responsibility perceptions.
• The study assessed real-world implementation of EULAR points to consider for comorbidity management.