Considerations for improving quality of care in rheumatoid arthritis and associated comorbidities

Abstract

Background: The presence of comorbidities in patients with rheumatoid arthritis (RA) contributes to increased morbidity and mortality(1). Patients with RA have an increased risk of comorbidities e.g. interstitial lung (IL) disease (7.7% incidence(2); up to 60% IL abnormalities in early RA(3)), depression (up to 200%(4); 16.8%(5)), cardiovascular disease (40-70%(6); 5-12.9%(7)) and diabetes (IR of 8.6 per 1000 person-years(8); 20%(9)). Yet, there are few comprehensive recommendations on the management of RA-related comorbidities. Objectives: This study aimed to identify models of good quality care for patients with RA and their associated comorbidities in Europe and understand how these practices can be widely implemented. Methods: Existing published recommendations across Europe on good practice in RA care including screening/managing selected comorbidities were reviewed. Team members of 12 specialist centres across Europe were interviewed. The interventions identified were reviewed and prioritised to form a selection of considerations by a consensus process involving 18 experts including rheumatologists, a patient rep., a nurse and also RA comorbidity specialists: cardiologist, psychologist, pulmonologist and diabetologist. Results: The interventions were prioritised for each patient profile: a. suspected RA: a. rapid access to care (online referral, triage, ultrasound–guided diagnosis) b. enhanced communication with primary care (hotline, education sessions) c. early arthritis clinic (timely clinical assessment and diagnosis) b. recently diagnosed: a. enabling self–management (self–monitoring and disease activity management support) b. early arthritis clinic c. comprehensive comorbidity assessment (standalone or in conjunction with RA appointment) c. established disease: a. dedicated comorbidity specialist b. integrating patient registries into daily clinical practice c. enabling self–management Eleven other interventions were identified including task-shifting to non-physician healthcare professionals, tailored education to patients and family members, and developing care networks. Conclusion: Despite limited European recommendations on management of RA comorbidities, a range of good practice care model interventions across Europe were identified which are non-complex, high-impact and meaningful. Next step will be to assess how these care models can be implemented in different healthcare systems for the benefit of patients with RA.