Interest of a systematic screening of comorbidities in chronic inflammatory rheumatisms.
Ms Amandine TUBERYa, Prof Pierre FESLERb, Dr Guilhem DU CAILARb, Prof Jacques MORELa, Prof Jean BOUSQUETc, Prof Bernard COMBEd, Dr Claire DAIENa
a CHRU Lapeyronie, Service de Rhumatologie, b CHRU Lapeyronie, Service de médecine interne, c INSERM, Montpellier, FRANCE, d Montpellier, Service de Rhumatologie
Background: Patients with chronic inflammatory rheumatisms (CIR) have a greater risk of cardiovascular events, infections, lung diseases and osteoporosis. European League Against Rheumatisms (EULAR) recommends annual evaluation of the cardiovascular risks.
Methods: A program of comorbidity screening was set up in a daily clinic of our Rheumatology department and includes 1) rheumatism evaluation; 2) cardiovascular evaluation ; clinical examination, blood tests, modified systematic coronary risk evaluation (mSCORE) calculation, vessel ultrasound and echocardiography, 3) lung evaluation ; self-questionnaires and spirometry; 4) osteoporosis ; bone mineral density and FRAX calculation, and 5) check-up of vaccinal status and the recommended neoplasic screenings.
Results: 92 patients already benefited from this systematic screening with 83% (n=76) of Rheumatoid Arthritis, 11% (n=10) of spondyloarthritis, 3% (n=2) of psoriatic arthritis and 4% (n=4) of other diseases. The mean rheumatism duration was14±9 years, the mean age was 59±11 years and 64% were women. Hypertension was diagnosed in 8.7% (n=8) of the patients; dyslipidemia in 9.8% (n=9); diabetes in 6.5% (n=6) of the patients. The echocardiography showed significant abnormalities (valvular and hypokinesia) in 9% (n=8) of the patients, a significant supra-aortic vessel stenosis was found in 4.5% (n=4) of the population and an abdominal aortic aneuvrysm was diagnosed in 5.7% (n=5). Among 92 patients, 18.4% (n=14) were estimated at high risk of lethal cardiovascular event with a mSCORE≥5 and 27.5% (n=25) patients were sent to a cardiologist to pursue further cardiovascular investigations. Among these, 8 had a myocardial scintigraphy and all were normal. Moreover, 32.6% (n=30) of the patients were estimated at risk of chronic obstructive pulmonary disease or sleep apnea syndrome and were recommended to consult pneumologist. An anti-osteoporosis drug was introduced in 12% (n=11) of the patients. The update of the vaccinations and the neoplasic screenings were prescribed for respectively 52.7% (n=48) and 35.2% (n=32) of the patients.
Discussion: A daily hospitalization for comorbidity screening seems worthy with significant abnormalities discovered in 36.2% of the patients. Further investigations were recommended in 50% of the patients. Patient’ satisfaction and the effective impact of the proposed or prescribed measures are under evaluation.
Keywords : Rheumatisms, Rheumatoid Arthritis, Screening, Comorbidity, Cardiovascular