Background/Purpose: Patients with RA are either more at risk of, or less well screened for, several comorbidities including cardiovascular (CV) risk, cancer, infections and osteoporosis.[1] In 2012, patients with established RA participated in a trial including a nurse visit for comorbidity counselling [2]. In the present follow-up study, we aimed to quantify both at study entry and 3 years after the trial ended, comorbidity screening and management in this population.

Methods: Study design:This was an open long term (3 years) extension of the COMEDRA 6 month randomized controlled trial in which patients with definite, stable RA were visiting a nurse for comorbidity counselling.[2] Comorbidity status was assessed and nurses provided advice on screening and management, at baseline and 3 years later. Outcome measure: A score was developed to quantify comorbidity screening and management: this score gives 50 points to CV risk (ie hypertension, diabetes, lipids, renal insufficiency), 20 points to cancer, 20 points to vaccination and 10 points to osteoporosis screening. Lower scores indicate better screening and management. Statistical analysis: The score was compared between baseline and 3-year assessment using a Wilcoxon test for paired data. For each comorbidity, the percentage of patients in conformity with screening and/or management recommendations was also assessed at both timepoints and compared using a MacNemar test for paired data.  

Results: Of the 970 recruited patients, 776 (80%) were followed up at 2-4 years and 769 (79%) had available data for comorbidities at both timepoints: mean (±SD) age 58 (±11) years, mean disease duration 14 (±10) years; 614 (80%) were women and 538 (70%) were receiving a biologic with a mean DAS28 of 3.0±1.3. At baseline, the mean comorbidity screening score was 36.6(±19.9) (range, 0-100) and it improved at 3 years to 24.3(±17.8) (p<0.0001) thus with a relative improvement of 33%. Patients in conformity with management recommendations improved most remarkably for CV risk screening, vaccination status and bone densitometry performance, whereas cancer screening improved less (Table).  

Conclusion: Comorbidity screening is suboptimal but has improved notably in this study over 3 years, after a nurse-led program aiming at checking systematically for comorbidity screening and giving patient advice. Improvements were particularly important for CV screening and vaccinations. This long-term efficacy pleads in favour of nurse-led interventions to better address comorbidities in RA.                                                    Ref 1. Baillet A, Gossec L  et al. Ann Rheum Dis. 2016;75(6):965-73.

Ref 2. Dougados M, Soubrier M, et al. Ann Rheum Dis. 2015;74(9):1725-33. Table % of patients in conformity with screening and management recommendations, for each comorbidity