Background There is a wide range of evidence of increased risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) and other forms of inflammatory arthritis. Although people wiht RA have an increased number of the traditional risk factors for the development of CVD, it seems the presentation of a chronic inflammatory state is pivotal because of the accelerate atherogenesis as a result of endotelial dysfunction, leading to increased thickness and plaque formation in carotid arteries. EULAR recommendations for CV risk advised to assess CV risk in all patients with RA, and the patient's risk should be scored according to the SCORE system. Nurse-led care is a model of care, where nurses manage their own patient caseload, monitor patients' sign and symptoms, provide education and refer appropriately.
Objectives The aim of this study was to assess CVD risk in patients with RA and other inflammatory arthritis, in a nurse-led clinic and, supported by a carotid ultrasonography (US).
Methods Patients with inflammatory arthritis (RA, PsA, SpA, SLE) attends a nurse-led clinic for diseases activity measurement and based in a self-efficacy framework, lifestyle change support and, CV risk assessment. Those patients with smoking habits, blood pressure above the recommended level and total colesterol above 250 mg/dl were follow up closer with the nurse based in a motivational interview, treatment were prescribed by the rheumatologist and written leaflets concerning smoking cessation, low-lipid diet were offered. The CV assessment included: age, gender, blood pressure, glucose, triglycerides, total cholesterol, HDL, LDL cholesterol, smoking habits, height, weight and BMI were measured. Presence and type of diabetes were asked. Patient's risk SCORE was calculated. The risk SCORE was multiplied by 1.5 if the patient met certain criteria associated with higher CV risk. No multiplication was proposed for other arthritides. In those patients with intermediate risk SCORE (1–4%) a carotid ultrasonography was performed by a rheumatologist.
Results 68 patients with inflammatory arthritis had an intermediate risk SCORE. 51 were RA, 13 SpA, 1 PsA, 3 SLE. Mean age: 60 years. 59% were women. Mean modified risk SCORE: 2,6%. Prior to performing US, 68 patients had intermediate risk SCORE. Media right IMT:0,77 mm, plaque was found in 19 patients (28%); media left IMT:0,82 and plaque was found in 27 patients (40%) Only 41% of our patients remained with intermediate riks SCORE after US. 43% patients had a very high risk SCORE after US and, 13% a high risk SCORE. Overall, a total of 48 patients (59%) had their CV risk upgraded after nurse and US assessment
Conclusions Adding carotid US to nurse assessment in CVD risk stratification in patient wiht inflammatory arthritis and intermediate risk SCORE increases performance, being thus, a helpful technique for a CV tight control.
Peters MJ et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 2010
Garcia-Diaz S, Corominas H. Nurse management of cardiovascular risk factors in rheumatoid arthritis. Br J Nurs 2013
Primdahl J et al. Nurses' Role in Cardiovascular Risk Assessment and Management in People with Inflammatory Arthritis: A European Perspective. Musculoskeletal Care 2015
Disclosure of Interest None declared