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We hypothesized that multimorbidity in IIM is heterogeneous, associated with demographic, clinical, and psychosocial factors, and linked to differences in physical function and fatigue. We studied 1028 adults with self-reported, specialist-confirmed IIM. Comorbidities were assessed using the Functional Comorbidity Index and categorized into basic, complex, mental-health, and autoimmune domains. Logistic regression identified factors associated with mental- and physical-health comorbidity; clustering defined comorbidity patterns. Participants were predominantly female (71.3%), median age 59.0\u00a0years. Overall, 46.7% had basic multimorbidity, 15.4% complex multimorbidity, 33.6% mental-health comorbidity, and 14.7% autoimmune multimorbidity. Interstitial lung disease was concentrated in anti-synthetase syndrome (50.7%) and polymyositis (42.6%), while hypertension (37.8%) and malignancy (35.0%) were concentrated in inclusion body myositis. Chronic pain\/fatigue syndromes were associated with mental-health burden (63.2% vs. 27.5%, p\u2009&lt;\u20090.001). Mental-health comorbidity was associated with younger age (OR 0.98\/year), complex multimorbidity (OR 2.85), immunosuppressive therapy (OR 1.53), and lower family support (OR 0.94\/unit). Physical-health comorbidity was independently associated with older age (OR 1.05\/year), mental-health comorbidity (OR 3.96), and overlap myositis (OR 3.33). Clustering identified three multimorbidity profiles: low-burden (49.3%), cardiometabolic\/malignancy-predominant with low mental-health burden (22.9%), and pain-fatigue\/mental-health-predominant (27.7%), which differed significantly in physical function and fatigue. Multimorbidity in IIM is common, heterogeneous, and shows a strong concurrent relationship between mental- and physical-health comorbidity, supporting integrated mental-health screening and subtype-tailored surveillance.<\/jats:p>","DOI":"10.1007\/s00296-026-06262-6","type":"journal-article","created":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T03:17:23Z","timestamp":1787973443000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mental- and physical-health comorbidity are strongly associated in idiopathic inflammatory myopathies: a multinational cross-sectional e-survey"],"prefix":"10.1007","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3682-4517","authenticated-orcid":false,"given":"Samuel 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Patterns of Comorbidity in Idiopathic Inflammatory Myopathies: A Cross-sectional Analysis of Disease Burden and Risk Factors [abstract]. Arthritis Rheumatol. 2025;77 (suppl 9). Available from:\n                      \n                      . Accessed July 11, 2026. No DOI is assigned to individual ACR Convergence abstracts. The present manuscript reflects an updated analysis with a refined study sample and expanded methodology. Claude AI (Anthropic large language model) was used solely to assist with spelling and grammar checks during manuscript preparation (May 2026). The authors reviewed, verified, and edited all AI-assisted suggestions and take full responsibility for the final content of the manuscript. No part of this report is copied, published elsewhere, or generated by AI. The views and opinions expressed are solely those of the author and do not represent or reflect those of any affiliated institution (LG).","order":3,"name":"Ethics","label":"Declarations","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"248"}}