Regarding cardiovascular risk factors, only a quarter of RA patients received all assessments for blood pressure, lipids, glycosylated hemoglobin and BMI. “[Because] RA increases the risk for cardiovascular events, it is imperative that primary care physicians understand and more aggressively manage cardiovascular risk in these patients,” write the authors. “This underscores the important role of family doctors in the comanagement of these conditions, and our findings indicate several areas in which primary care for RA patients could be improved.”
For hypertension, a similar number of patients had a blood pressure reading exceeding the cutoff target of greater than 160/100 mm-Hg, 6.1% of RA patients vs. 5.4% of non-RA patients. Also, 5.3% of RA patients vs. 3.9% of non-RA patients with ischemic heart disease had a blood pressure readings exceeding 160/100 mm-Hg, and less than half of patients had a low-density lipoprotein cholesterol measurement of less than 2.0 mmol/L—42.0% in the RA group vs .47.3% in the non-RA group. (Note: No significant difference was detected in the management of diabetes mellitus between RA and non-RA patients with the condition.)
The authors emphasize the importance of understanding the screening and care practices used in the primary care setting to develop targeted strategies to prevent comorbidities in RA patients and improve care. “Our findings suggest a need for clear guidelines for rheumatologists and primary care providers regarding comanagement of comorbidities in patients with RA,” they conclude.
Widdifield J, Ivers NM, Bernatsky S, et al. Primary care screening and comorbidity management in rheumatoid arthritis in Ontario, Canada. Arthritis Care Res (Hoboken). 2018 Oct;69(10). doi: 10.1002/acr.23178.