Background Rheumatoid arthritis (RA) is associated to a higher cardiovascular risk (CVR), prevalence of cardiovascular events and cardiovascular mortality than the general population. Adequate control of disease activity and cardiovascular risk factors(CVRF), reduces cardiovascular morbidity and mortality in this population. While control of disease activity is assumed by the rheumatologist, control of CVRF could be undertaken by both the rheumatologist and the general practitioner (GP).
Objectives To evaluate the impact of involving GP in the control of CVRF in patients with rheumatoid arthritis.
Methods All RA patients that came for a follow-up visit between March 2012 and December 2012 were included. For each patient, we assessed CVRF (body mass index, smoking, blood pressure, serum glucose, total cholesterol, LDL cholesterol and triglycerides) and calculated the SCORE and the modified SCORE. Patients were informed of the convenience of making for intervention to reduce their CVRF. Each patient was handed a letter addressed to their GP in which their cooperation in the control of CVRF was requested. The letter also included a clear explanation of the importance of CVRF control in patients with RA. In addition, specific therapeutic goals to achieve were outlined as follows: LDL cholesterol: 1.7 mmol/L (70 mg/dL) for patients with high CVR (mSCORE ≥ 5%) or that had suffered a cardiovascular event and 2.5 mmol/L (100mg/dL) for the rest of the patients. In the next follow-up visit, we assessed whether there had been any intervention made by the GP, and whether therapeutic goals were achieved.
Results We studied 211 patients (171 (81%) women) with a mean age of 60 ± 12 years and a duration of RA of 13 ± 9 years. RF was + in 72%, anti-CCP+ 70%. 70% of patients were being treated with glucocorticoids, 86%with DMARD and 32% with biological treatment. According to DAS28 criteria, 71% had low, 27%, moderate and 2% high disease activity. At the initial evaluation, 25% of patients were overweight, 17% smoked, 51% were hypertensive, 6% were hyperglycemic, 53% had a total serum cholesterol > 5.2mmol/L (200 mg/dL), and 23% were hypertriglyceridemic. Five percent of patients had no CVRF, 20% had one, 34% two, 28% three, and 13%, more than three. There were new diagnoses of CVRF in 100 patients (47%): 1 new diagnosis of diabetes, 18 of hypertension, 82 of elevated LDL cholesterol and 27 of hypertriglyceridemia. The goal level for LDL was determined to be 1.7mmol/L for 29% of patients. GP made treatment changes in 2 of 12 cases of diabetes, 30 of 84 cases of arterial hypertension, 74 of 167 cases of elevated LDL cholesterol and 21 of 51 cases of hypertriglyceridemia in which changes in treatment were indicated. Overall, the percentages of adequate CVRF control before and after the intervention were, respectively: in diabetes, 48% and 44%; in hypertension, 25% and 73%; in elevated LDL cholesterol 10 and 17%; and in hypertriglyceridemia, 25% and 38%.
Conclusions Through our intervention, at least one new CVRF was diagnosed in a high percentage of patients. The response of GP, as measured by changes made in drug regimens, is considered insufficient. As a result, control of CVRF and mainly dyslipidemia in RA patients remains suboptimal.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.