TABLE 1

CVD risk in the common immune-mediated inflammatory diseases

Spondyloarthritis Inflammatory bowel disease

Crohn ’ s disease

Ulcerative colitis

skin disease . ^{14 , 15} Another example with a significant burden of disease is ankylosing spondylitis , which affects the axial skeleton with sacroiliac joint involvement , and causes decreased spinal mobility in some patients . ¹⁵

In addition to burden due to IMID symptoms , patients with IMIDs also have increased risk of comorbidity . ² For instance , patients with RA have on average two or more comorbidities , ¹⁶ with the number increasing with patient age . ² This multimorbidity is due to an increased risk of developing other IMID-related conditions in patients diagnosed with an IMID compared with matched control patients . ^{2 , 5} A nationwide cohort study in Denmark reported that 22.5 % of patients with IBD also had at least one concurrent IMID . ¹⁷ Reasons may include overlapping susceptibility loci , shared pathogenic inflammatory pathways and common environmental risk factors ( e . g ., smoking , diet ). ¹⁷

Patients with IMID are also at increased risk of infections and cardiovascular disease ( CVD ), including atherosclerotic CVD , heart failure , arrhythmias , deep venous thrombosis and pulmonary embolism . ⁷ Systemic inflammation , which is a feature of IMID , is thought to accelerate atherosclerosis , whereby chronic inflammation enhances endothelial dysfunction and induces maladaptive remodelling of the vascular wall . ⁷ Results of a prospective , population-based cohort study in the UK found that psoriasis is an independent risk factor for myocardial infarction ( MI ), with MI risk being greatest in young patients with severe psoriasis . ¹⁸

Among patients with IMIDs , there is also an increased risk of cancer . ¹⁹ Organ-specific IMIDs are associated with increased risk of malignancy in the involved organs , with associations reported between IBD and colorectal cancer , primary sclerosing cholangitis and hepatobiliary cancer , and coeliac disease and cancer of the small intestine . ¹⁹ Some IMIDs may be associated with higher risk of cancer in the distant organs ( e . g ., Crohn ’ s disease with extracolonic cancer , and ulcerative colitis with hepatobiliary cancer ). ¹⁹

Psychiatric comorbidity , including depression , anxiety and bipolar disorder , is also more common in individuals with IMID compared with the general population . ²⁰ The increased risk for psychiatric comorbidity among patients with IMID may be due to a common underlying biology that is influenced by genetic and environmental ( including psychosocial ) factors . ²⁰

Consequently , IMIDs cause a significant reduction in patients ’ quality of life , ^{4 , 13} with studies showing an affect across all dimensions of health , including mental health . ¹⁵ A study in patients with inflammatory rheumatic diseases demonstrated poorer self-reported health status in all domains of living , compared with individuals without arthritis . This was particularly evident in domains relating to physical functioning or mobility , role limitation due to physical health problems and usual activities , and bodily pain . ¹⁵ Associated comorbidities , such as CVD and psychiatric comorbidity , also contribute to loss of quality of life . ^{7 , 20}

Lastly , IMIDs also have a socioeconomic impact , affecting an individual ’ s employment status and work-related productivity . ^{4 , 21} These disorders typically affect people in their prime working years , and therefore have a considerable effect on an individual ’ s employment status . ²¹

Mortality burden Evidence shows that individuals with IMIDs have a reduced life expectancy and increased mortality compared with the general population . ^{2 , 7} The lifespan of patients with RA is reduced by 3 – 10 years depending on disease severity and age at disease onset , ²² while lifespan of male and female patients with severe psoriasis is reduced by 3.5 and 4.4 years , respectively , compared with healthy controls . ¹⁸ Patients with RA and significant functional disability have a threefold increased risk of mortality compared with that of the general population . ¹⁵ Results of a nationwide register study in Denmark found that type 1 diabetes , an IMID , carries a 70 % higher mortality risk than type 2 diabetes . ²³

For some IMIDs ( e . g ., RA and spondyloarthritis ), the majority of excess deaths are attributable to CVD . ⁷ However , evidence suggests that there has been a trend toward a reduction in CVD death among patients with RA over recent years because of the availability of an increased number of treatment options . This has translated into a reduction in cardiovascular mortality , but a similar reduction in other causes of excess mortality among patients with RA ( i . e ., neoplasms and respiratory causes ) has not been observed . ²⁴

Health system burden IMIDs place a significant burden on healthcare systems due to the chronic and disabling nature of these disorders . ²⁵ For example , a 2016 study of the use of healthcare by patients with psoriasis in Catalonia , Spain revealed a mean of 8.7 primary care visits , 2.8 outpatient visits , 0.5 emergency and day hospital visits , 0.2 mental health visits , and use of 6.1 medications . ²⁶ An analysis of the burden of IBD in Europe in 2020 reported that half of patients with Crohn ’ s disease were hospitalised at least once within 5 years , and 20 %– 50 % of

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