Relevance and feasibility of a systematic screening of multimorbidities in patients with chronic inflammatory rheumatic diseases

Joint Bone Spine. 2019 Jan;86(1):49-54. doi: 10.1016/j.jbspin.2018.03.016. Epub 2018 Apr 11.

Abstract

Objectives: EULAR recently proposed to screen multimorbidities in chronic inflammatory rheumatic diseases. The aims of the study were to define the most common multimorbidities in chronic inflammatory rheumatic diseases, compare the screening approach performed in the clinic with the recent EULAR recommendations, validate the points to consider for the systematic standardized multimorbidity screening proposed by EULAR and assess feasibility of such a screening in a daily clinic.

Methods: Data were collected prospectively during a 1-day multimorbidity clinic. Diabetes, hypertension, CVD damage, chronic respiratory diseases, osteoporosis and preventive measures were assessed. The comparison with EULAR points to consider was performed retrospectively.

Results: We included 200 consecutive patients (157 with rheumatoid arthritis, 37 spondyloarthritis, and 6 connective tissue diseases or vasculitis). The most common multimorbidities already diagnosed in our patients were hypertension (26%) and diabetes (7.5%). Screening showed that 61.5% (CI95%: 54.6%-67.9%) patients presented at least one undiagnosed or uncontrolled diseases: diabetes (6%), hypertension (20.6%), dyslipidemia (16.1%) valvulopathies (16.8%), peripheral artery disease (4.5%); carotid stenosis (6.5%) and aortic aneurysm (5.5%). Overall, 39.9% patients had incomplete cancer screening and 52.8% incomplete vaccine schedule. Undiagnosed pulmonary obstruction and risk of sleep apnea were suspected in 15.5% and 40.1% patients, respectively.

Conclusion: This study underlines the relevance of a systematic screening of multimorbidities in chronic inflammatory rheumatic diseases and its feasibility in a 1-day clinic. Spirometry and sleep apnea screening should be added to EULAR points to consider. The long-term impact of such screening needs to be evaluated.

Keywords: Cardiovascular disease risk; EULAR point to consider; Lung disease; Multimorbidity; Psoriatic arthritis; Rheumatoid arthritis; Screening; Spondyloarthritis; Vaccination.

MeSH terms

  • Aged
  • Arthritis, Rheumatoid / epidemiology
  • Chronic Disease / epidemiology
  • Connective Tissue Diseases / epidemiology
  • Feasibility Studies
  • Female
  • Humans
  • Lung Diseases / epidemiology
  • Lupus Erythematosus, Systemic / epidemiology
  • Male
  • Mass Screening / methods*
  • Middle Aged
  • Multimorbidity*
  • Polymyositis
  • Rheumatic Diseases / epidemiology*
  • Risk Assessment
  • Risk Factors
  • Spondylarthritis / epidemiology
  • Vasculitis / epidemiology