Background Patients with rheumatoid arthritis are known to have a long term disability and increased risk of extra-articular comorbidities. EULAR guidelines suggest annual review of cardiovascular risk in patients with rheumatoid arthritis  whilst UK national (NICE) guidelines suggest a more holistic annual review to look at the impact of the disease on quality of life as well as co-morbidities .
Objectives Our aim was to look at the annual reviews currently taking place in primary care to see how frequently patient co-morbidities were assessed and documented. We then implemented a formal community rheumatology interface review to assess whether this improved patient care.
Methods A large primary care practice (16,000 patients) was offered a community rheumatology interface review by a secondary care clinician. A search was undertaken for patients with rheumatoid arthritis who had attended for an annual primary care review between December 2015–2016. Of these 30 reviews were selected and we assessed how frequently the following were recorded; DAS28, HAQ score, FRAX score, Q-Risk2 (CV risk assessment tool) and screening for depression. Once we had analysed these results we implemented a community rheumatology interface review and assessed compliance with the above outcomes had improved compared to standard primary care management.
Results In patients assessed prior to implementation of interface review, we found that a DAS28 score was recorded in 0%, HAQ score in 0%, FRAX in 13%, Q-Risk2 in 10% and depression screening in 23%.
In comparison, patients assessed by a community rheumatology interface clinician recorded DAS28 in 100%, HAQ score in 100%, FRAX in 100%, Q-Risk2 in 100% and depression screening was recorded in 100%. Based on improved interface review 7 patients (23%) were sent for DEXA scanning or started on a bisphosphonate, we discussed cardiovascular risk and starting a statin in 8 patients (26%) and 7 patients (23%) required follow-up for mental health. Of the 30 patients in this cohort all patients reported full adherence to their anti-rheumatic regime.
Conclusions 1. An annual review with a rheumatology interface practitioner is of benefit in holistic patient care and improved compliance with all domains of the annual review.
2. Management of metabolic bone, cardiovascular and mental health issues was improved, according to current national guidelines.
Peters M 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 69:325–331.
National Institute for Health and Clinical Excellence (NICE) (2009). Rheumatoid Arthritis in Adults: Management. Clinical Guideline 79. London: NICE.
Disclosure of Interest None declared
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