Interest of a systematic screening of comorbidities in chronic inflammatory rheumatisms

BackgroundPatients with chronic inflammatory rheumatisms (CIR) have a greater risk of cardiovascular events, infections, lung diseases and osteoporosis. European League against Rheumatisms (EULAR) recommends annual evaluation of the cardiovascular risks.MethodsA program of comorbidity screening was set up in a daily clinic of our Rheumatology department and includes:– rheumatism evaluation;– cardiovascular evaluation; clinical examination, blood tests, modified systematic coronary risk evaluation (mSCORE) calculation, vessel ultrasound and echocardiography;– lung evaluation; self-questionnaires and spirometry;– osteoporosis; bone mineral density and FRAX calculation;– check-up of vaccinal status and the recommended neoplasic screenings.ResultsNinety-two patients already benefited from this systematic screening with 83% (n=76) of rheumatoid arthritis, 11% (n=10) of spondyloarthritis, 3% (n=2) of psoriatic arthritis and 4% (n=4) of other diseases. The mean rheumatism duration was 14±9 years, the mean age was 59±11 years and 64% were women. Hypertension was diagnosed in 8.7% (n=8) of the patients; dyslipidemia in 9.8% (n=9); diabetes in 6.5% (n=6) of the patients. The echocardiography showed significant abnormalities (valvular and hypokinesia) in 9% (n=8) of the patients, a significant supra-aortic vessel stenosis was found in 4.5% (n=4) of the population and an abdominal aortic aneuvrysm was diagnosed in 5.7% (n=5). Among 92 patients, 18.4% (n=14) were estimated at high risk of lethal cardiovascular event with a mSCORE≥5 and 27.5% (n=25) patients were sent to a cardiologist to pursue further cardiovascular investigations. Among these, 8 had a myocardial scintigraphy and all were normal. Moreover, 32.6% (n=30) of the patients were estimated at risk of chronic obstructive pulmonary disease or sleep apnea syndrome and were recommended to consult pneumologist. An anti-osteoporosis drug was introduced in 12% (n=11) of the patients. The update of the vaccinations and the neoplasic screenings were prescribed for respectively 52.7% (n=48) and 35.2% (n=32) of the patients.DiscussionA daily hospitalization for comorbidity screening seems worthy with significant abnormalities discovered in 36.2% of the patients. Further investigations were recommended in 50% of the patients. Patient’ satisfaction and the effective impact of the proposed or prescribed measures are under evaluation