People living with inflammatory rheumatic diseases face a heightened risk of cardiovascular disease, infections, malignancies, depression and osteoporosis, driven both by the chronic inflammatory state underlying their conditions and by the immunomodulatory therapies used to control disease activity. European Alliance of Associations for Rheumatology guidance is explicit that the rheumatology team should play a central role in detecting, documenting and screening for these comorbidities, while collaborating closely with general practitioners. Yet a large new cross-sectional survey from Germany suggests that, in everyday practice, this guidance is far from fully realised, and that patients and their rheumatologists hold strikingly different views about what is actually being done and who should be doing it.
The study, published in Arthritis Research & Therapy, analysed anonymous online questionnaires completed by 2,213 patients with inflammatory rheumatic diseases and 140 rheumatologists across Germany. Patients were eligible if they reported a diagnosed inflammatory rheumatic disease and attended regular rheumatology appointments; rheumatologists qualified if they treated such patients in outpatient settings. Recruitment ran from 18 August 2025 to 2 January 2026, reaching patients through patient organisations and social media channels, and physicians through email invitations from the German Society for Rheumatology and Clinical Immunology and the Professional Association of German Rheumatologists, as well as direct invitations at the German Rheumatology Congress in September 2025. No financial incentives were offered, and the survey was designed and reported according to the CHERRIES guidelines for web-based surveys.
The patient cohort was predominantly female, at 92.1 percent, with most participants aged between 50 and 69 years. Rheumatoid arthritis was the most frequently reported diagnosis at 45.5 percent, followed by connective tissue diseases at 29.3 percent and psoriatic arthritis at 28.0 percent. Among the rheumatologists, 55.7 percent were female, all worked in outpatient clinics, and years of experience were broadly distributed. Weekly patient volume typically ranged from 20 to 100 patients, and most physicians reported spending 30 minutes or less on initial consultations and 15 minutes or less on follow-up visits. Notably, university-based rheumatologists were less experienced, saw fewer patients per week, and reported longer consultation times than their non-university colleagues.
The headline finding was the sheer scale of the gap between what rheumatologists reported doing and what patients reported experiencing. Mean patient-reported implementation of comorbidity management across five domains — cardiovascular risk, infections, malignancies, depression and osteoporosis — was just 28.8 percent. Rheumatologists reported substantially higher implementation in every domain. The largest discrepancies appeared in blood pressure monitoring, reported by 83.6 percent of rheumatologists but only 33.8 percent of patients; vaccination status checks, at 77.9 percent versus 33.2 percent; and osteoporosis screening, at 92.1 percent versus 32.3 percent. Cancer screening advice showed the widest single gap of all, with 70.7 percent of rheumatologists reporting they provided it compared with just 12.1 percent of patients.
The authors caution that several factors could contribute to this mismatch. Patients may simply not recall or recognise screening measures that took place, particularly if they occurred outside rheumatology visits, and differences in patient awareness could play a role. But the survey’s authors also point to a less comfortable possibility: because preventive care in inflammatory rheumatic diseases has repeatedly been reported as suboptimal in prior studies, the discrepancy may partly reflect social desirability bias in physician reporting. Supporting this interpretation, a Dutch survey found that only 39 percent of patients with rheumatoid arthritis had been informed of their increased cardiovascular risk despite rheumatologists reporting active involvement in preventive care, and a large rheumatoid arthritis registry recorded a 12-month prevalence of depressive symptoms of 11.7 percent among patients compared with only 1.0 percent as reported by their rheumatologists.
Structural gaps in the clinics themselves may compound the problem. A majority of rheumatologists, 69.3 percent, reported that their clinics had no structured approach to comorbidity screening at all. About half, 52.9 percent, documented comorbidities at regular intervals, and in most cases the rheumatologists themselves carried out the screening. When asked about barriers, 91.4 percent cited lack of time, 48.6 percent pointed to unclear responsibilities, 40.0 percent reported staff shortages, and 35.0 percent flagged a lack of incentives or reimbursement. These barriers echo findings from other studies of preventive care in rheumatology, and they paint a picture of willing physicians working within systems that give comorbidity care no protected space.
Responsibility, meanwhile, is perceived very differently by the two groups. Rheumatologists most often favoured sharing documentation and screening duties with general practitioners, at 61.4 percent and 48.6 percent respectively, while assigning treatment to general practitioners alone in 60.7 percent of responses. Patients, by contrast, more frequently assigned primary responsibility to their general practitioners, particularly for cardiovascular risk management at 72.6 percent and vaccinations at 73.8 percent. Depression screening was an exception in the other direction: 19.3 percent of patients but only 6.4 percent of rheumatologists considered it the rheumatologist’s job. Osteoporosis screening was the only domain where the two groups closely aligned, with 47.3 percent of patients and 52.1 percent of rheumatologists assigning primary responsibility to rheumatologists. Encouragingly, 88.7 percent of patients felt responsibility for their general health should be shared between their general practitioner and rheumatologist, and 89.1 percent agreed that mental health should be a topic that can be raised during rheumatology consultations.
The survey also revealed that comorbidity care is not distributed evenly across patient groups. Older patients were more likely to have their blood pressure measured and to be informed about preventive screening examinations, while patients attending rheumatology more frequently were more likely to be asked about depression and vaccination status and to receive information about preventive screening. Patients with connective tissue diseases reported participating in preventive measures more often overall. Meanwhile, a majority of patients, 59.1 percent, disagreed with the statement that their rheumatologist had a good overview of their other health conditions beyond their inflammatory rheumatic disease — a worrying signal given that disease-specific risks and screening recommendations may be overlooked when neither physician clearly owns them, especially if primary care physicians are not fully aware of the elevated comorbidity burden in these conditions.
The study has important limitations that shape how its findings should be read. All data were self-reported and anonymous, so nothing could be verified against medical records, and recall and reporting biases cannot be excluded. The overwhelming female majority among patient respondents may limit representativeness, although the authors note that comparable German surveys of inflammatory rheumatic disease cohorts have reported similarly high proportions of female participants, between 91 and 94 percent. Recruitment through patient organisations and online communities likely favoured highly engaged patients, and physicians recruited through professional bodies may have had particular interest in comorbidity management. Because the two groups were recruited independently, differences between their responses represent group-level rather than paired comparisons. The authors also note that specific investigations, particularly bone-density measurement and individual cancer screening procedures, depend on individual risk or eligibility and may not be indicated for every patient, and that view, participation and completion rates could not be calculated because recruitment used open links.
What emerges is less a story of negligent physicians than one of a structural problem in shared care. Many rheumatologists in the survey were willing to take at least some responsibility for documenting and screening comorbidities, yet that willingness did not appear to translate into routine practice, and current guidelines remain insufficiently specific about who does what. The authors argue that clearer role definitions, stronger guidance from rheumatology organisations, and practical tools such as checklists or app-based support are needed. Prior evidence suggests such tools can work: systematic multimorbidity screening has been shown to increase the use of preventive medications and was associated with reduced hospitalisations, structured arthritis clinic models with clearly defined staff tasks substantially increased recording of cardiovascular risk factors, and nurse-led interventions and printed individualised checklists improved screening and preventive management. The authors state that further research should inform updated EULAR guidance and future recommendations on comorbidity care.
Subject of Research: A cross-sectional survey of patients and rheumatologists in Germany examining the implementation of comorbidity management and perceived responsibility in inflammatory rheumatic disease care.
Article Title: Comorbidity management in inflammatory rheumatic diseases: a dual-perspective survey of patients and rheumatologists
Article References: Bartsch, V., Habboub, B., Knitza, J., Ausserwinkler, M., Knop, S., Schett, G., & Hueber, A. J. (2026). Comorbidity management in inflammatory rheumatic diseases: a dual-perspective survey of patients and rheumatologists. Arthritis Research & Therapy, 28(1), Article 187. https://doi.org/10.1186/s13075-026-03924-5
Image Credits: AI Generated
DOI: 10.1186/s13075-026-03924-5
Keywords: inflammatory rheumatic diseases, comorbidity management, EULAR recommendations, rheumatologists, general practitioners, cross-sectional survey, cardiovascular risk, vaccination, osteoporosis screening, depression screening, preventive care, Germany
News Source: Glenn Wilkins. (October 28, 2026). Patients and Rheumatologists Sharply Disagree on Who Manages Comorbidities in Inflammatory Rheumatic Disease Care. Scienmag.
