Rheumatoid arthritis (RA) is a chronic disease that causes pain, stiffness, swelling, and
limitation in the motion and function of multiple joints. Though joints
are the principal body parts affected by RA, inflammation can develop in
other organs as well. An estimated 1.3 million Americans have RA, and
the disease typically affects women twice as often as men.
Patients with RA have an increased prevalence for coronary heart
disease (CHD). Some data suggests that RA patients are not being
screened properly for hyperlipidemia, so researchers at the University
of Alabama at Birmingham conducted a study to evaluate lipid testing
patterns among RA patients. They looked at whether patients screened for
hyperlipidemia received care from a primary-care physician (PCP), a
rheumatologist or both.
‘Rheumatoid arthritis patients whose rheumatologists and primary-care physicians coordinate their care have a higher likelihood of being screened for hyperlipidemia.’
Patients with rheumatoid arthritis whose rheumatologists and
primary-care physicians coordinate their care have a higher likelihood
of being screened for hyperlipidemia, a key risk factor for coronary
heart disease, suggested new research findings presented this week at
the 2016 ACR/ARHP Annual Meeting in Washington.
The study was conducted to identify the extent of the screening and
management gaps for hyperlipidemia among the RA patient population, said
Iris Navarro-Millan, Assistant Professor of Medicine at UAB and a
lead author of the study.
"You could argue that screening for hyperlipidemia, a traditional
risk factor, should be addressed by primary-care physicians, but there
are a number of patients with RA who only see a rheumatologist," she
said. "Patients see a specialist for a comorbidity (in this case RA),
and do not establish care with a PCP, and this results in gaps in
standard of care, such as screening and management for hyperlipidemia.
We decided to focus on hyperlipidemia because CHD is the most common
cause of death among patients with RA. Therapies for RA also affect
lipid profiles in these patients, which adds complexity to the issue of
cardiovascular risk reduction in patients with RA."
The study linked commercial and public health plan claims data
together from 2006 to 2010. Participants in the study were required to
have at least 12 months of continuous medical and pharmacy coverage at
baseline, have two or more physician diagnoses plus relevant DMARD
and/or biologic prescriptions to categorize them as having RA, plus two
years of follow-up. Excluded were patients with prevalent myocardial
infarction (MI), stroke or CHD at baseline, or those who had a diagnosis
of hyperlipidemia or were using hyperlipidemia medications at baseline.
The researchers organized the patterns of care at baseline as
visited a PCP only, visited a rheumatologist only or visited both types
of physicians. They used logistic regression to determine the how likely
patients were to be screened for hyperlipidemia during two years of
follow-up based on their pattern of care.The study measured
hyperlipidemia screening in 13,319 RA patients, including 83%
women. 26% were between the ages of 41-60 and 74%
were older than 65. 18% of the RA patients did not see a
PCP at the 12-month baseline.
The results showed that 42% of patients seeing a PCP only
were screened for hyperlipidemia, 40% of patients seeing only a
rheumatologist were screened, and 47% of patients seeing both a
PCP and rheumatologist were screened. After controlling for multiple
potential confounders, the researchers found that RA patients who
received combined care had a 32% increase in the likelihood of
being screened for hyperlipidemia.
Rheumatologists may not always consider hyperlipidemia screenings as
part of RA patient care, the researchers concluded. Improved
coordination of care between PCPs and rheumatologists could help RA
patients get necessary cardiovascular screenings. The study's findings
help raise awareness that the RA patient population is inadequately
screened and managed for hyperlipidemia, said Dr. Navarro-Millan.
"Our goal is to develop an intervention that can facilitate
communication between specialties with the goal of decreasing health
care fragmentation and reduce CHD risk in these patients," she said. "We
anticipate that patient activation and knowledge will be a key element
for the success of such intervention, since patients with RA are less
likely to be aware of their increased risk for CHD."