TABLE 6.
Consensus statements on management of comorbidities
| Comorbid condition/s | Treatment options/referral/monitoring | Treatment requiring caution |
|---|---|---|
| Cardiovascular disease and congestive heart failure | JAKi, ustekinumab, IL‐17i, IL‐23i, abatacept 73 , 74 , 75 , 76 |
NSAIDs, GCCs, TNFi (TNFi should be avoided in patients with severe CHF [NYHA class III and IV] and should be used with caution in patients with mild CHF [NYHA class I and II]) 9 , 54 , 143 , 144 |
| Obesity and metabolic syndrome | Weight reduction, nutritionist referral, obesity/endocrine clinic referral | MTX, GCCs 9 |
| Hypercholesterolemia | Lipid‐lowering agents, nutritionist referral | Tofacitinib 77 |
| Hypertension | Statins, angiotensin‐converting enzyme inhibitors, and/or angiotensin II blockers 9 |
NSAIDs, GCCs 9 |
| Diabetes mellitus | Hypoglycemic medications | MTX, GCCs 9 |
| IBD |
TNFi (excluding etanercept) for UC (tofacitinib, IL‐12/23i) IL‐23i 84 |
IL‐17i |
| Uveitis | TNFi (especially adalimumab and infliximab), MTX | NSAIDs, IL‐17i 145 |
| Depression | Psychiatry referral | Apremilast |
| Hyperuricemia and gout |
Monitoring serum uric acid levels Urate‐lowering therapy if indicated |
|
| Thyroid disease | Routine thyroid tests/endocrine referral | |
| Osteoporosis | Monitor with DEXA as indicated in non‐PsA patients | GCCs |
| Malignancy | Oncology referral, IL‐17i, abatacept | All biological agents |
| Fatty liver disease |
GI referral Weight loss Dietician referral |
NSAIDs, SSZ, MTX, LEF, tofacitinib 54 |
| Chronic kidney disease | Nephrologist referral | NSAIDs, MTX 54 |
| HBV |
Ustekinumab GI referral, monitor HBV PCR (once a mo for first 3 mo and every 3 mo thereafter) 146 |
NSAIDs, MTX, LEF, biologics (for carriers) 54 |
| HCV | GI referral, monitor HCV PCR (once in every 3‐6 mo) 146 | NSAIDs, MTX, LEF, biologics (for carriers) 54 |
| Tuberculosis | IL‐17i, abatacept, referral to respiratory or infectious disease specialist | TNFi especially infliximab |
Abbreviations: CHF, congestive heart failure; DEXA, dual‐energy X‐ray absorptiometry; GCCs, glucocorticoids; GI, gastrointestinal; HBV, hepatitis B virus; HCV, hepatitis C virus; IBD, inflammatory bowel disease; IL‐12/23i, interleukin‐12/23 inhibitor; IL‐17i, interleukin‐17 inhibitor; IL‐23i, interleukin‐23 inhibitor; JAKi, Janus kinase inhibitor; LEF, leflunomide; MTX, methotrexate; NHYA, New York Heart Association; NSAIDs, non‐steroidal anti‐inflammatory drugs; PCR, polymerase chain reaction; SSZ, sulfasalazine; TNFi, tumor necrosis factor inhibitor; UC, ulcerative colitis.