Mental Health

Mental- and physical-health comorbidity are strongly associated in idiopathic inflammatory myopathies: a multinational cross-sectional e-survey.

TL;DR

Multimorbidity in IIM is common, heterogeneous, and shows a strong concurrent relationship between mental- and physical-health comorbidity, supporting integrated mental-health screening and subtype-tailored surveillance.

Key Findings

Multimorbidity was highly prevalent in IIM, with 46.7% of participants having basic multimorbidity, 15.4% complex multimorbidity, 33.6% mental-health comorbidity, and 14.7% autoimmune multimorbidity.

  • Study included 1028 adults with self-reported, specialist-confirmed IIM.
  • Participants were predominantly female (71.3%) with a median age of 59.0 years.
  • Comorbidities were assessed using the Functional Comorbidity Index and categorized into basic, complex, mental-health, and autoimmune domains.
  • This was a multinational cross-sectional e-survey design.

Comorbidity patterns were heterogeneous across IIM subtypes, with interstitial lung disease concentrated in anti-synthetase syndrome and polymyositis, while hypertension and malignancy were concentrated in inclusion body myositis.

  • Interstitial lung disease was present in 50.7% of anti-synthetase syndrome cases and 42.6% of polymyositis cases.
  • Hypertension (37.8%) and malignancy (35.0%) were concentrated in inclusion body myositis.
  • These subtype-specific patterns suggest a need for subtype-tailored surveillance strategies.

Chronic pain and fatigue syndromes were strongly associated with mental-health comorbidity burden.

  • Chronic pain/fatigue syndromes were present in 63.2% of those with mental-health comorbidity compared to 27.5% of those without (p < 0.001).
  • This association suggests a strong bidirectional relationship between pain, fatigue, and mental health in IIM.

Mental-health comorbidity was independently associated with younger age, complex multimorbidity, immunosuppressive therapy, and lower family support.

  • Younger age was associated with mental-health comorbidity (OR 0.98 per year).
  • Complex multimorbidity was associated with mental-health comorbidity (OR 2.85).
  • Immunosuppressive therapy was associated with mental-health comorbidity (OR 1.53).
  • Lower family support was associated with mental-health comorbidity (OR 0.94 per unit).
  • Associations were identified using logistic regression.

Physical-health comorbidity was independently associated with older age, mental-health comorbidity, and overlap myositis.

  • Older age was associated with physical-health comorbidity (OR 1.05 per year).
  • Mental-health comorbidity was strongly associated with physical-health comorbidity (OR 3.96).
  • Overlap myositis was associated with physical-health comorbidity (OR 3.33).
  • The bidirectional association between mental- and physical-health comorbidity was a central finding.

Cluster analysis identified three distinct multimorbidity profiles in IIM that differed significantly in physical function and fatigue.

  • The three profiles were: low-burden (49.3%), cardiometabolic/malignancy-predominant with low mental-health burden (22.9%), and pain-fatigue/mental-health-predominant (27.7%).
  • The three clusters differed significantly in physical function and fatigue outcomes.
  • The pain-fatigue/mental-health-predominant cluster represented over a quarter of the study population.
  • Clustering methodology was used to define comorbidity patterns.

The strong concurrent relationship between mental- and physical-health comorbidity supports integrated mental-health screening in IIM care.

  • Mental-health comorbidity was associated with physical-health comorbidity with OR 3.96, and physical-health comorbidity was associated with mental-health comorbidity with OR 2.85.
  • The authors concluded that subtype-tailored surveillance and integrated mental-health screening are warranted.
  • Patient-reported outcomes including physical function and fatigue differed significantly across multimorbidity clusters.

What This Means

This research surveyed over 1,000 adults diagnosed with idiopathic inflammatory myopathies (IIM) — a group of rare autoimmune diseases that cause muscle inflammation — across multiple countries. The study found that having multiple health conditions at the same time (multimorbidity) is very common in IIM, affecting the majority of patients in some form. Nearly half had two or more general health conditions, one-third had mental health conditions such as depression or anxiety, and about one in seven had multiple autoimmune diseases. Different subtypes of IIM tended to cluster with different types of additional health problems: for example, lung disease was more common in certain subtypes, while cancer and high blood pressure were more common in inclusion body myositis. A particularly striking finding was the strong two-way relationship between mental and physical health comorbidities. Patients with mental health conditions were nearly four times more likely to also have significant physical health conditions, and vice versa. Chronic pain and fatigue syndromes were especially linked to mental health burden. The researchers also identified three distinct 'profiles' of patients based on their pattern of comorbidities: about half had relatively low overall burden, roughly one-quarter had mainly heart, metabolic, or cancer-related conditions with less mental health involvement, and about one-quarter had a profile dominated by pain, fatigue, and mental health conditions — this last group had notably worse physical function and fatigue. This research suggests that treating IIM patients requires attention to both physical and mental health simultaneously, rather than addressing them separately. The findings point to the importance of routine mental health screening for IIM patients, particularly those who are younger, on immunosuppressive therapy, or who have less family support. The identification of distinct comorbidity profiles also suggests that different patients may benefit from different monitoring and treatment strategies tailored to their specific pattern of health conditions.

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Citation

Shinjo S, Rahulan L, Shah M, Chauhan A, Hussain S, Jordan P, et al.. (2026). Mental- and physical-health comorbidity are strongly associated in idiopathic inflammatory myopathies: a multinational cross-sectional e-survey.. Rheumatology international. https://doi.org/10.1007/s00296-026-06262-6