Anti-Rheumatic Therapy and Comorbidity

Anti-rheumatic medications have improved survival and quality of life for patients with rheumatic diseases. Published guidelines help physicians select the appropriate therapy from among the traditional immunosuppressants and disease-modifying agents to the newer small molecules and biologic drugs. However, given the paucity of data for patients with comorbidities, not surprisingly these evidenced-based guidelines do not address the use of anti-rheumatic medications for patients with many of the common chronic medical illnesses. Biologic and chronic disease registries although providing the long-term follow-up needed to evaluate the safety of specific anti-rheumatic drugs are susceptible to the channeling of patients to specific therapies based on the presumed risk of complications. In this chapter we review some of the published data of anti-rheumatic drugs in patients with chronic medical illnesses and provide recommendations.