Dr. Maxime Dougados presented EULAR's suggestions for what is felt to be the minimal level of comorbitity assessment by rheumatologists. Much of this assessment is intended to be done through self-reporting questionnaires or with the assistance of healthcare practitioners.
The need for a consistent approach is evident as the comorbidities in patients with chronic inflammatory rheumatic disease (CIRD) are less optimally managed than in the general population. This includes various aspects from management of hypertension to screening for breast cancer.
The EULAR committee establishing these recommendations did not intend for rheumatologists to have to manage and treat all comorbidities identified but rather to implement a standardized assessment tool in practice. The following comorbidities were identified for screening: ischemic CVD, malignancies, infection, peptic ulcer, osteoporosis and depression.
The assessment tool will be posted this week on the EULAR website for clinician use. Its components include questions on:
The last known assessment for cervical, skin, breast and colon cancer to ensure national guidelines for screening are being followed.
Past serious infections requiring hospitalization, past and current viruses, TB screenig and vaccination status.
Assessment of petic ulcer risk includes age, past or current ulcers, use of anticoagulants etc.
Osteoporosis screening will ensure a BMD and Frax score have been charted.
Past diagnosis or screening for depression and if treatment was needed.
Cardiovascular risk will include BP, a complete lipid panel and risk score calculation based on the new EULAR recommendation of multiplying the risk score by a factor of 1.5.
No specific guidelines were recommended for assessing pulmonary disease, however through questioning on past infections, TB assessment and cancer screening, changes in lung function are hoped to be identified. Since the EULAR committee's mandate was to recommend the minimum comorbidity assessment, further lung function assessment is at the discretion of the rheumatologist.
The EULAR committee is hopeful that the newly developed tool will be broadly adopted in practice but understands that the use of health professional teams in rheumatology may be required to make this a reality.
Carolyn Whiskin, BSc. Phm is currently the director of pharmacy programs for the Charlton Centre for Specialized Treatments in Hamilton, Ontario. She also practices pharmacy at Brant Arts Dispensary in Burlington, Ontario and is the pharmacist representative to the Ontario Rheumatology Association’s Model of Care committee.View Full Bio