Background/Purpose: Rheumatoid Arthritis (RA) carries a considerable increase of the risks for cardiovascular (CV) disease. It is unclear how well patients with RA understand such risks and what they do to minimize them. This study was designed to determine whether a structured approach (detailed explanation and a concise brochure) is more effective than a verbal explanation delivered to the patient when the diagnosis of RA is made.

Methods: Existing patients with an established diagnosis of RA followed at the Dallas Arthritis Center were administered a questionnaire. These patients had been given the traditional verbal explanation of CV risks. In the interventional phase of the study, newly diagnosed RA patients were given a simple brochure that illustrated CV risks associated with RA and suggested strategies to minimize them. The contents of the brochure were discussed with the patients in a structured fashion, i.e., by rigorously following the scheme in the brochure and by answering patients’ questions as each point was presented. In a follow-up visit after the diagnosis, the questionnaire was administered to patients who had received the structured explanation and the brochure. Responses of the two groups were compared using unadjusted odds ratios and the chi-square test.

Results:  A total of 53 patients completed the questionnaire in the first phase and 33 completed the second phase. In group 1 (non-structured explanation with no brochure) 22 of the 53 patients (41.5%) indicated that they could recall having been given an explanation of the CV risks associated with RA and being encouraged to make appropriate life-style changes. However, 31 patients (58.5%) had no such recollection. In group 2 (structured explanation and brochure) 22 of 33 patients (66.7%) indicated that they could recall having been given an explanation of the CV risks associated with RA and being encouraged to make appropriate life-style changes, while 11 (33.3%) had no such recollection. This represents a highly significant change with respect to group 1, where only 41.5% recalled having received instructions (OR 2.82 95% CI 1.14 – 6.98; p<0.05). Patients’ responses regarding lifestyle changes made are depicted in Table 1.

Conclusion: A brief structured explanation of CV risks associated with RA was more effective than a less formal unstructured explanation given as part of the initial or follow up encounters with regards to smoking behavior and switching to a healthier diet. Approximately half of the patients reported increasing their commitment to exercise, irrespective of how the suggestion was delivered and whether they recalled or not being given the advice. A high proportion of patients (4 out of 5) reported seeing their primary care provider (PCP), and structured or unstructured recommendations seemed to have little effect on this behavior.

Table 1 – Responses of the two groups stratified according to recollection.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/educating-patients-on-the-cardiovascular-risks-of-rheumatoid-arthritis-usual-care-versus-a-structured-approach/