Search

The field of rheumatology has shown great interest in comorbidity-related risk among patients with rheumatoid arthritis (RA). A recent paper reported that a person with RA has a similar risk of sustaining a myocardial infarction as a person with diabetes mellitus (DM), and this risk is comparable to that of a healthy person 10 years older.1 Several other papers have also recently reported that people with RA and DM share a similar cardiovascular risk.2 3 These findings are strikingly similar to those of the Charlson Index published 25 years ago.4 The Charlson Comorbidity Index is the most commonly used prognostic measure of illness burden in contemporary clinical research.5 Cited in nearly 7000 studies, it is considered the gold standard to assess comorbid risk in clinical research.6 Over time the Charlson Index has increased in use and relevance, likely related to increased rates of chronic disease, supporting the need to measure and adjust for these conditions in research. The original objective was to develop a prognostic taxonomy for comorbid conditions that could singly or in combination prognosticate …

Excellent treatment options exist. So why don't we all prevent or treat it? When doctors institute steroids for any illness and for any length of time, they take on a lifelong responsibility to that patient to both taper the drug as quickly as is possible and safe and prevent or treat the many well recognised steroid related side effects.1 This is particularly true when steroid treatment lasts for more than one month and certainly for many months or years. Rheumatologists have a particular accountability because of the 1% of the population who are receiving long term steroids, most have rheumatological disorders.2,3 Further, rheumatologists should have the best understanding of when the treatment course will be prolonged, the profound and negative physiological impact of steroids on bone, and the need to deal with this important issue in both men and women.4,5 A recent topic search for steroid-induced osteoporosis (SIO) yielded 79 000 articles since 1966 and 13 000 since l998, most of which focused on the pathogenesis, clinical manifestations, and treatment of SIO. Despite the saturation publication on this topic for years, doctors do …