Background Increased cardiovascular risk is well documented in rheumatoid arthritis (RA). Annual reviews, incorporating cardiovascular (CV) risk on RA patients set by the National Institute for Health and Clinical Excellence (NICE) are well established in the UK (1). Emerging research shows increased CV risk in psoriatic arthritis (PsA) (2) together with well established CV risk in ankylosing spondylitis and SLE (3,4).
A decision was made to undertake annual review on all inflammatory patients following the NICE guidelines for RA (CG79). This included non CV risk factors: osteoporosis risk, depression, general health (BP, BMI, smoking, alcohol, exercise, diabetes risk), HAQ, medication review, MDT referrals. Extra nurse-led clinics were set up to bring down waiting times in the clinics for follow up patients, and introduce annual review assessments.
Objectives We already have a robust system in place in order to highlight cardiovascular risk and educate patients on prevention of CV disease in RA. As the system is well established and working well, we extended the service to incorporate all patients with inflammatory disease. We set out to audit our non-RA patients to see whether they have increased CV risk factors.
Methods We conducted a small retrospective audit of PsA patients between January and October 2014. 10 patients are booked per week in a dedicated annual review clinic, 45 minutes per patient. The annual review proforma was designed for all patients with inflammatory arthritis. Conditions seen included RA, PsA, AS, SLE, CTD, sero neg inflammatory arthropathy, other (inflammatory OA, vasculitis, sjogren's).
Results In the first 10 months, 150 patients were seen.
RA 81, PsA 24, SLE 9, CTD 3, inflammatory arthropathy 21, AS 6, other 5.
24 patients with psoriatic arthritis were seen in the annual review clinic in the first 10 months. We identified abnormalities of the following PsA patients: Blood pressure 2 (patients), waist circumference 16, BMI 10, urinalysis 6, smoking 2, alcohol 1, exercise 12, DEXA 1, lipids 17, MDT 6, depression 4.
These patients were referred back to their General Practitioners for them to address the risk factors.
Conclusions We have found that out of the 24 patients with PsA, we identified a high number of CV risk factors which needed addressing, this is in line with current evidence of patients with inflammatory disease. At present, there are guidelines in place for RA patients to assess and monitor CV risk (1), it may be time to include all other types of inflammatory rheumatic conditions in this assessment process. We plan to continue for another 12 months and then undertake an audit to see whether an annual review on all inflammatory patients is worthwhile. This audit demonstrates the need to address modifiable risk factors in patients with PsA.
Rheumatoid arthritis: The management of rheumatoid arthritis in adults. NICE guidelines (CG79) published February 2009.
Kristensen SL, McInness IB, Sattar N. Psoriasis, psoriatic arthritis and cardiovascular risk: are we closer to a clinical recommendation? Annuls of the Rheumatic Diseases 2015; 74:321-322.
Momeni M, Taylor N, Tehrani M. Cardiopulmonary Manifestations of Ankylosing Spondylitis. International Journal of Rheumatology 2011, Article ID 728471.
McMahon M, Hahn BH, Skaggs BJ. Systemic Lupus Erythematosus and Cardiovascular Disease, Prediction and Potential for Therapeutic Intervention. Expert Review of Clinical Immunology. 2011:7(2):227-241.
Disclosure of Interest None declared