Background/Purpose: Patients with rheumatoid
arthritis (RA) have high coronary heart disease (CHD) burden and accelerated
atherosclerotic status. However, limited data suggest that these patients may
be screened less frequently than other patients with similar CHD risk.  To
evaluate the rate of lipid testing and management among RA patients and compare
it both to the general population and diabetes (DM) patients.

Methods:   We used a mix of private and public health
plans claims data from 2006 to 2010 with medical and pharmacy coverage.
Eligible participants were required to 1) have at least 12 months of continuous
medical and pharmacy coverage (baseline period), and 2) have 2+ physician
diagnosis and relevant medications to categorize them as having 1) RA and DM;
2) RA only; 3) DM only; 4) Neither RA nor DM. Patients with prevalent myocardial
infarction (MI)/stroke/CHD during baseline were excluded. Each of these groups
had a follow up time of 2 years. We calculated the proportion of patients with low
density lipoprotein (LDL) lab test during the 2 year follow-up. In a subgroup
analysis, we determined the proportion of patients with lab results available
with LDL ≥ 130 mg/dL that initiated treatment with statins. We use
chi-square tests to compare differences between the 4 cohorts in the proportion
tested for LDL and initiating statins.

Results: There were 428,109 eligible patients distributed
between the 4 cohorts (Table). Overall, 60% were women. The overall age
distribution was:  12% ≤ 40; 29%, 41-65; and 59% >65 years old. RA
patients were less frequently tested for LDL compared to DM patients, with or
without RA (p-value <0.001 for all comparisons) (Table). Conditional on
having LDL ≥ 130 mg/dL, RA patients were less likely to be started on a
statin compared to DM patients (p-value < 0.001), and were marginally more
likely to be initiated on statins compared to the general population (p-value =
0.045). There was no difference in the statin prescription trend between DM and
RA patients vs. only RA patients (p-value =0.083)

Conclusion: RA patients are less frequently screened
and managed for hyperlipidemia compared DM patients. Despite higher CHD risks
in RA patients, hyperlipidemia screening and treatment rates in RA patients
were no better than the general population. Further studies to investigate the
reasons and potential interventions to ameliorate this care gap among RA
patients are needed.

Table: Frequency of lipid testing among patients with rheumatoid
arthritis, diabetes, both or neither condition