Considerations for everyday management
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People with rheumatic and musculoskeletal diseases (RMD) are at risk of a number of comorbidities, from cardiovascular diseases to cognitive impairment and fractures. The 2026 annual Congress of EULAR – The European Alliance of Associations for Rheumatology – took place in London, showcasing new data and ideas around various comorbidities and drug safety issues in people with an RMD – and highlighting the need for integrated care.
Systemic autoimmune diseases are associated with increased cardiovascular morbidity and mortality – possibly through autonomic imbalance, myocardial inflammation, or fibrotic infiltration of the conduction system. A team in Colombia have been looking into the risk of cardiac arrhythmias and conduction disorders in adults with systemic autoimmune diseases compared with the general population – with the aim of identifying disease-specific patterns from a systematic review and meta-analysis. The work was presented in a poster at the 2026 Congress by Juan Sebastian Theran Leon and colleagues. Data from 40 studies were included, representing over 210,000 patients and more than 800,000 controls. Results showed the pooled risk of arrhythmia was significantly higher in those with an autoimmune disease versus controls. Systemic sclerosis and rheumatoid arthritis had the strongest associations, particularly with atrial fibrillation, ventricular arrhythmias, and atrioventricular block. Routine ECG and Holter monitoring should be considered as part of the standard evaluation of autoimmune patients to enable early detection and prevention of rhythm disturbances.
Like many RMD, juvenile idiopathic arthritis (JIA) is characterised by chronic inflammation, and associated with an increased risk of major comorbidities, including cardiovascular disease, chronic kidney disease, and type 2 diabetes. But knowledge is limited about the risk of these comorbidities and all-cause mortality in adults with JIA compared to matched comparators. Imane Bardan explored this question using data from the Norwegian Patient Registry, finding a higher prevalence of ischemic heart disease, hypertension, and chronic kidney disease in adults with JIA, as well as other autoimmune conditions such as type 1 diabetes, celiac disease, autoimmune thyroiditis, and alopecia. Prospective all-cause mortality was higher in JIA than comparators, with a mortality rate of 2.4 versus 1.8 per 1,000 person-years. Neither comorbidities, autoimmune conditions, or all-cause mortality appeared to be affected by recent exposure to disease-modifying antirheumatic drugs. The work underscores the need for integrated care throughout adulthood.
Another poster at the Congress focused on cognitive impairment – a recognised and clinically meaningful comorbidity in immune-mediated inflammatory disorders. Alex Kaula and colleagues from Cambridge Cognition presented their findings on the feasibility, reliability, and sensitivity of a 90-second cognitive assessment delivered by smartphone to RMD patients, using data from the IDEA-FAST study. This examined healthy volunteers alongside participants with an RMD (inflammatory bowel disease, Sjögren’s disease, rheumatoid arthritis, or systemic lupus erythematosus) as well as two neurodegenerative diseases – seeing how they compared on a digit-symbol substitution task. Results showed the assessment had good/excellent reliability across cohorts. People with an RMD had differences in cognitive performance (total number of items correct in 90 seconds) compared to healthy volunteers, ranging from –3.2 in inflammatory bowel disease to –6.7 in systemic lupis erythematosus. For reference, using the same age-adjusted model recorded differences of –11 in Parkinson’s and –10 in Huntington’s disease – providing a clear and clinically interpretable context for the observed effects. These kind of low-burden assessments that can be delivered remotely could help address longstanding barriers to incorporating cognitive assessment into large-scale studies and disease monitoring in patients with RMD.
Some risks associated with RMD come from the drugs used in management, as well as from the underlying disease. Many people take a proton pump inhibitor (PPI) – either as an over-the-counter option for chronic acid reflux, or as protection against stomach ulcers for those prescribed long-term nonsteroidal anti-inflammatory drugs. Cécile Philippoteaux was the first author on a poster delving into increasing concerns around the long-term safety of PPI – specifically major osteoporotic fractures – using data from OSIRIS, a retrospective population-based cohort in France. A total of 1,372,763 matched individuals were analysed. During follow-up, the proportion of patients experiencing at least one major osteoporotic fractures was significantly higher in the PPI-exposed group than in controls. This finding held true at all sites, including hip, vertebrae, humerus, and wrist. Age-stratified analyses revealed a non-linear pattern, with the highest excess fracture risk observed in people aged 60–69 years – possibly highlighting a critical risk window. The risk increased with longer duration of PPI exposure, particularly for hip and vertebral fractures. In survival analyses, chronic PPI exposure was also associated with increased all-cause mortality, with consistently lower survival probability in exposed individuals. These findings support the need for stricter adherence to guidelines, regular re-evaluation of PPI prescriptions, and the implementation of targeted fracture prevention strategies in chronic users – an important place where rheumatologists may play a key role.
Janus kinase inhibitors (JAKi) are approved for rheumatoid arthritis and other chronic inflammatory diseases. Whilst highly effective, safety signals from clinical trials and from some observational studies suggest a possible increase in the risk of venous thromboembolism (VTE).1 An oral abstract presentation on Wednesday 3rd June included findings from the Swedish Rheumatology Quality Register, looking at the incidence of VTE in over 25,000 rheumatoid arthritis patients treated with JAKi, tumour necrosis factor inhibitors (TNFi), or other biologics. Based on 347 recorded VTE events, the age- and sex-standardised incidence rate was 8.3 per 1,000 person-years for patients treated with a JAKi, 7.3 for IL-6i, 4.3 for TNFi, 5.9 for rituximab, and 4.0 for abatacept, versus 2.9 for the general population. The fully adjusted hazard ratio for VTE with JAKi versus TNFi was 1.89 – suggesting patients with rheumatoid arthritis treated with JAKi experience a higher VTE risk than those on TNFi.
Presenting the work, Maxime Raffray said “Our data confirm earlier findings that JAKi are linked to an increased risk of VTE. However, this increased risk does not seem to be unique to JAKi. Importantly, the size of this risk should be considered alongside the benefits JAKi provides. In our study, we estimate that treating 250 patients with a JAKi instead of a TNFi for one year would result in approximately one additional case of VTE. Further investigations on the potential effects of each individual JAKi drug are underway.”
Source
Theran Leon JS, et al. Cardiac Arrhythmias and Conduction Disorders in Autoimmune Diseases: A Systematic Review and Meta-Analysis. Presented at EULAR 2026; POS0159. Ann Rheum Dis 2026; DOI: 10.1136/annrheumdis-2026-eular.B.70.
Bardan I, et al. Long-term Outcomes of Juvenile Idiopathic Arthritis in Adulthood: a Population-Based Matched Comparator Study from Norway. Presented at EULAR 2026; OP0190. Ann Rheum Dis 2026; DOI: 10.1136/annrheumdis-2026-eular.B.1011.
Kaula A, et al. Brief, Daily, Remote, Digital Cognitive Assessments in Immune-Mediated Inflammatory Disorders (IMIDs): Findings from a Large Longitudinal Multi-Cohort Study. Presented at EULAR 2026; POS0381. Ann Rheum Dis 2026; DOI: 10.1136/annrheumdis-2026-eular.B.2859.
Philippoteaux C, et al. Proton Pump Inhibitors Exposure, Fracture and Mortality Risk in a Nationwide Matched Cohort: Results from the French OSIRIS Study. Presented at EULAR 2026; POS1219. Ann Rheum Dis 2026; DOI: 10.1136/annrheumdis-2026-eular.B.2925.
Raffray M, et al. Venous thromboembolism with Janus kinase inhibitors and other immunomodulatory drugs: a Swedish comparative safety study among patients with rheumatoid arthritis. Presented at EULAR 2026; OP085. Ann Rheum Dis 2026; DOI: 10.1136/annrheumdis-2026-eular.B.1917.
References
1. Molander V, et al. Venous thromboembolism with JAK inhibitors and other immune-modulatory drugs: a Swedish comparative safety study among patients with rheumatoid arthritis. Ann Rheum Dis 2023;82(2):189–97. DOI: 10.1136/ard-2022-223050.