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

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

Author information

1
Department of Rheumatology, CHU de Montpellier, 34000 Montpellier, France; Montpellier University, 34000 Montpellier, France; Institut de génétique moléculaire Montpellier, UMR5535, CNRS, 34000 Montpellier, France. Electronic address: cidaien@gmail.com.
2
Department of Rheumatology, CHU de Montpellier, 34000 Montpellier, France; Montpellier University, 34000 Montpellier, France.
3
Montpellier University, 34000 Montpellier, France; Internal medicine and hypertension, CHU Montpellier, 34000 Montpellier, France.
4
Department of medical information, Montpellier University, 34295 Montpellier, France.
5
Montpellier University, 34000 Montpellier, France; Department of cardiology, CHU de Montpellier, 34295 Montpellier, France.
6
Department of Rheumatology, CHU de Montpellier, 34000 Montpellier, France; Montpellier University, 34000 Montpellier, France; Institut de génétique moléculaire Montpellier, UMR5535, CNRS, 34000 Montpellier, France.
7
MACVIA-France, 34000 Montpellier, France.
8
Montpellier University, 34000 Montpellier, France; Internal medicine and hypertension, CHU Montpellier, 34000 Montpellier, France; Department of medical information, Montpellier University, 34295 Montpellier, France; National Institute for Health and Medical Research (INSERM), U1046, 34000 Montpellier, France.

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

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