Background/Purpose: Patients with inflammatory rheumatisms especially rheumatoid arthritis (RA) have a greater risk of cardiovascular diseases (CVD), infections, chronic respiratory diseases (CRD) and osteoporosis. As recommended by EULAR, rheumatologists start to perform systematic screening of CVD and comorbidities. Moreover, the 2015 EULAR guidelines recommend assessment of asymptomatic atherosclerotic plaques by carotid ultrasound. We aimed to determine the real impact of this strategy.

Methods: A screening was set up in an out-patient daily clinic of Rheumatology. It included 1) cardiovascular evaluation with modified SCORE calculation, supra-aortic trunks and abdominal aorta ultrasound and echocardiography, 2) CRD evaluation with spirometry; 3)  osteoporosis with bone mineral density and FRAX calculation, and 4) check-up of vaccine calendar and recommended neoplasia screenings. Three months later, patients were called and the application of recommendation evaluated. 

Results: 184 patients including 150 RA patients and 29 spondyloarthritis performed this screening. The mean rheumatism duration was 14±9 years and the mean age was 59±11 years. Unknown uncontrolled hypertension was diagnosed in 14% (n=26); dyslipidemia in 21% (n=38); diabetes in 8% (n=14) of the patients. 26% (n=47) patients were estimated at risk of chronic obstructive pulmonary disease or sleep apnea syndrome and were recommended to perform further explorations. Anti-osteoporosis drugs were prescribed in 11% (n=21) patients. Vaccinations and neoplasia screening updates were proposed for 53% (n=97) and 41% (n=75) patients. Only one clinically significant carotid stenosis requiring therapy  was found (0.5%). Mild to moderate stenosis were found in 8/168 patients (4.7%). Abdominal aorta aneuvrysm requiring monitoring were detected in 8/168 patients (4.7%). Patients with detected carotid stenosis or  aorta aneuvrym were significantly older (65±9 vs 58±11 years, p=0.01), more often male (58 vs 29%, p=0.01), with higher waist circumference (99±16 vs 92±14 cm, p=0.03) and mSCORE (4.4±3.6 vs 2.1±2.2, p<0.001). A mSCORE ≥4.5 would detect vascular Doppler abnormalities with a 88% sensitivity and a 43% specificity. Abnormal echocardiography was found in 30/184 patients (25 patients with valvular diseases, 3 hypokinesia and 5 left ventricular hypertrophia). Three months after screening, 84 patients were contacted by phone. 6/10 declared to have recommendation for hypertension, 5/8 for diabetes and 6/10 for osteoporosis. 14/29 declared to have performed the recommended CRD explorations, 30/40 the vaccines and 18/36 the neoplasia screenings.

Conclusion: A daily out-patient clinic for comorbidity screening helps to detect chronic diseases such as hypertension, diabetes, dyslipidemia, or osteoporosis requiring treatment in a 1/3 of patients. Chronic respiratory diseases were also detected in 26% patients. 50 to 75% of the recommendations proposed appeared to be applied. Profitability of systematic supra-aortic trunk doppler appears to be low with only 0.5% of clinically significant abnormalities. The use of systematic vascular ultrasonography should probably be limited to a more targeted population such as patients with a mSCORE≥4.5.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-systematic-screening-of-comorbidities-by-the-rheumatologist-in-inflammatory-rheumatisms-impacts-chronic-disease-care/