In a third scenario that’s increasing in popularity, the patient can visit collaborative clinics and be seen by specialists from both sides of the fence, Dr. Bathon says.
Collaborative Care at Clinics
Some institutions with joint rheumatology–cardiology clinics include Mayo Clinic, Cleveland Clinic and Johns Hopkins in Baltimore.
“This greatly fosters coordination of care and better management and permits a more systematic evaluation and collection of relevant data in these patients,” says Dr. Matteson. “Something we see a lot is that because of the dominance of the rheumatic disease in terms of symptoms and the effect on day-to-day life, other important health aspects, such as cardiovascular disease assessment, are often neglected.” This motivated specialists to have the combined clinic, he says.
At Cleveland Clinic, the connection is made with the help of electronic medical records, Dr. Husni says. When tracking information about a person diagnosed with lupus or psoriatic arthritis, for example, an electronic best practice alert reminder pops up and prompts the physician to refer to preventive cardiology. By doing this for at least five years, Cleveland Clinic has been able to raise patient awareness about cardiovascular risk factor screening and management, and specialists are looking more closely at novel biomarkers that could reveal who is at greater risk for heart disease, Dr. Husni says.
Moving Forward
More sophisticated diagnostic tools will help make heart risks associated with rheumatic disease easier to spot, Dr. Bokhari says. “There has been a great deal of advancement in non-invasive imaging for the diagnosis of rheumatoid heart disease. With the help of echocardiography, cardiac MRI, and radionuclide imaging, symptomatic patients can be diagnosed,” he says.
As rheumatologists and cardiologists move toward greater collaboration at the practice level, there are also more efforts to research issues of joint interest.
For example, there’s research underway to investigate whether methotrexate can reduce the rate of second heart attacks compared with placebo, Dr. Bathon says. There is also a clinical trial now to compare etanercept (Enbrel) with tocilizumab (Actemra) to evaluate the risk for heart disease in RA patients, adds Dr. Bathon, who is a former editor of the journal Arthritis & Rheumatology.
Researchers are still trying to track why patients with certain rheumatic diseases are at greater risk for heart issues—and why certain patients are at an even higher risk beyond the traditional risk factors, such as smoking or being overweight, Dr. Husni says.
There’s also a large trial underway called PRECISION to assess the cardiovascular effects of daily celecoxib (Celebrex) and ibuprofen compared with naproxen, which are commonly used in RA and osteoarthritis patients for arthritis pain, says Dr. Husni (Cleveland Clinic is a sponsor of the trial). The prospective study involves more than 22,000 patients at increased risk of developing cardiovascular disease. Results should be reported in about a year, she says.
