Rheumatoid arthritis contributes to comorbidity burden through systemic inflammation and autoimmunity: examples of atherosclerotic cardiovascular disease, interstitial lung disease, and depression

PURPOSE OF REVIEW: To summarize the recent literature investigating systemic impact of rheumatoid arthritis (RA) on comorbidity burden, using atherosclerotic cardiovascular disease (ASCVD), interstitial lung disease (ILD), and depression as examples. RECENT FINDINGS: People with RA have consistently higher rates of comorbidities compared to the general population that include ASCVD, ILD, and depression. In addition to enrichment of traditional risk factors such as smoking and obesity, people with RA have unique factors related to inflammation, autoimmunity, and medications that contribute to excess comorbidities across diverse organ systems. Specific inflammatory pathways contribute to excess ASCVD in RA perhaps through dysregulated lipid metabolism. Trials for ASCVD prevention have been performed or underway for several RA medications. Seropositivity and high articular disease activity are associated with RA-ILD that may lead to lung fibrosis/inflammation. Several antifibrotic medications show utility in RA-ILD, and the contribution of specific anti-inflammatory medications is being investigated. Pain from uncontrolled inflammation and autoimmunity may impact mental health, leading to higher risk of depression in people with RA. SUMMARY: RA contributes directly and indirectly to comorbidity burden across diverse organ systems through systemic inflammation and autoimmunity. While further work is needed, controlling RA disease activity through specific RA medications may mitigate excess risk for comorbidities such as ASCVD, ILD, and depression risk.