scholarly journals Considerations for improving quality of care of patients with rheumatoid arthritis and associated comorbidities

RMD Open ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e001211 ◽  
Author(s):  
Tore K Kvien ◽  
Alejandro Balsa ◽  
Neil Betteridge ◽  
Maya H Buch ◽  
Patrick Durez ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Primary Care ◽  
Good Practice ◽  
Research Literature ◽  
Inflammatory Disorder ◽  
Management Support ◽  
Patient Registries ◽  
Self Monitoring ◽  
Increased Risk ◽  
Delays In Diagnosis

ObjectiveRheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder with a global prevalence of approximately 0.5–1%. Patients with RA are at an increased risk of developing comorbidities (eg, cardiovascular disease, pulmonary disease, diabetes and depression). Despite this, there are limited recommendations for the management and implementation of associated comorbidities. This study aimed to identify good practice interventions in the care of RA and associated comorbidities.MethodsA combination of primary research (180+ interviews with specialists across 12 European rheumatology centres) and secondary research (literature review of existing publications and guidelines/recommendations) were used to identify challenges in management and corresponding good practice interventions. Findings were prioritised and reviewed by a group of 18 rheumatology experts including rheumatologists, comorbidity experts, a patient representative and a highly specialised nurse.ResultsChallenges throughout the patient pathway (including delays in diagnosis and referral, shortage of rheumatologists, limited awareness of primary care professionals) and 18 good practice interventions were identified in the study. The expert group segmented and prioritised interventions according to three distinct stages of the disease: (1) suspected RA, (2) recent diagnosis of RA and (3) established RA. Examples of good practice interventions included enabling self-management (self-monitoring and disease management support, for example, lifestyle adaptations); early arthritis clinic; rapid access to care (online referral, triage, ultrasound-guided diagnosis); dedicated comorbidity specialists; enhanced communication with primary care (hotline, education sessions); and integrating patient registries into daily clinical practice.ConclusionLearning from implementation of good practice interventions in centres across Europe provides an opportunity to more widely improved care for patients with RA and associated comorbidities.

scholarly journals Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance Using Cardiovascular Quality Indicators

2016 ◽  
Vol 43 (11) ◽  
pp. 1965-1973 ◽  
Author(s):  
Claire E.H. Barber ◽  
John M. Esdaile ◽  
Liam O. Martin ◽  
Peter Faris ◽  
Cheryl Barnabe ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Primary Care ◽  
Quality Indicators ◽  
Care Physician ◽  
Pass Rate ◽  
Early Disease ◽  
Cvd Risk ◽  
Systematic Assessment ◽  
Increased Risk ◽  
Low Performance

Objective.Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice.Methods.Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate.Results.There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%–100% for yrs 1 and 2, respectively).Conclusion.Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.

A Severe Necrotizing Inflammatory Reaction of Leg Wounds Following Autologous Peripheral Blood Total Nucleated Cells Treatment in an Old Patient With Rheumatoid Arthritis and No-Option Chronic Limb-Threatening Ischemia: Is Cell Therapy Suitable for All Patients?

2021 ◽  
pp. 153473462199757
Author(s):  
Valerio Vallini ◽  
Luigi Venturini ◽  
Paolo Carnesecchi ◽  
Roberto Andreini ◽  
Simone Meini
Keyword(s):  
Rheumatoid Arthritis ◽  
Cell Therapy ◽  
Inflammatory Reaction ◽  
Peripheral Blood ◽  
Mononuclear Cells ◽  
Inflammatory Diseases ◽  
Inflammatory Disorder ◽  
Skin Atrophy ◽  
Chronic Inflammatory Disorder ◽  
Increased Risk

Chronic limb-threatening ischemia (CLTI) represents an unfavorable evolution of peripheral artery disease, characterized by pain at rest, ulceration, and gangrene and also by an increased risk of cardiovascular events, amputations, and death. According to scientific literature, in almost one third of cases affected by CLTI, defined as no-option CLTI patients, revascularization strategies are not feasible. In the past decade, several studies investigated the role of therapeutic angiogenesis through cell autologous therapy, administered through intramuscular injections or multiple local intralesional and perilesional injections. In this article, we report the case of a necrotizing inflammatory reaction in a patient affected by CLTI and chronic leg wounds that occurred on the multiple injection sites after autologous peripheral blood-derived mononuclear cells (PB-TNCs) transplantation. Since the patient was affected by corticosteroid-induced skin atrophy and rheumatoid arthritis, we hypothesize that an increased skin fragility and a mechanism of immune-mediated pathergy could have been main factors leading to worsening of wounds. This case report strongly suggests the urgent need to better define the indications and contraindications of cell therapy, and further studies of adequate methodology are required to definitively assess the efficacy and safety of autologous cell therapy by local injections of PB-TNCs in patients with chronic inflammatory disorder, such as rheumatoid arthritis, especially in case of concomitant marked skin atrophy. Pending definitive evidence from literature, a strong caution is needed in patients affected by chronic systemic inflammatory diseases, since multiple injections, acting as mechanical stimulus and pathergy trigger, might exacerbate a severe and uncontrolled inflammatory response.

scholarly journals Rheumatoid Arthritis Management for General Internists

2016 ◽  
Vol 8 ◽  
Author(s):  
Mitchell Uh MD FRCPC ◽  
David Collins MD FRCPC ABIM
Keyword(s):  
Rheumatoid Arthritis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Joint Destruction ◽  
Morbidity And Mortality ◽  
Inflammatory Disorder ◽  
General Internists ◽  
Canadian Population ◽  
Increased Risk ◽  
Significant Disability

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder that causes progressive joint destruction, deformity, and significant disability. In addition to arthritis, RA is associated with numerous extra-articular features with attendant morbidity and mortality. These include but are not limited to ocular inflammation, interstitial lung disease, pleuropericardial disease, vasculitis, accelerated atherosclerosis, and increased risk of lymphoma. The prevalence of RA in the Canadian population is approximately 1%.

scholarly journals Rate of Infection in Rheumatoid Arthritis Patients

2014 ◽  
Vol 4 (1) ◽  
pp. 15-21
Author(s):  
Aisha A. Al Ghamdi ◽  
Suzan M. Attar
Keyword(s):  
Rheumatoid Arthritis ◽  
University Hospital ◽  
Inflammatory Disorder ◽  
Risk Of Infection ◽  
Kingdom Of Saudi Arabia ◽  
Steroid Use ◽  
Increased Risk ◽  
King Abdulaziz University ◽  
Associated Risk Factors ◽  
Common Infections

Objectives: Rheumatoid arthritis is an autoimmune inflammatory disorder associated with increased risk of infection. The aim of this study was to evaluate infections frequency in rheumatoid arthritis patients and to report the independent associated risk factors. Methods: Rheumatoid arthritis patients (n = 200) were retrospectively reviewed at King Abdulaziz University Hospital Jeddah, Kingdom of Saudi Arabia from January 2008 to December 2010. The rate and predictors of infection were evaluated. Results: The frequency of infection in rheumatoid arthritis patients was (36%). The most common infections were pneumonia, bacteremia and urinary tract infection occurring in 18%, 12%, and 10%, respectively. The strongest and significant predictors for infection were cardiovascular disease (OR = 8.87), renal impairment (OR = 7.12), and steroid use (OR = 1.67). Conclusions: Infection rate in rheumatoid arthritis patients was high but lower than other studies. Comorbid illnesses (renal and cardiovascular diseases) and steroids in rheumatoid arthritis patients predisposed them to develop infections that may necessitate hospitalization. Comorbid illnesses should be managed early and steroids to be used cautiously in order to reduce infection risk among rheumatoid arthritis patients.

scholarly journals Rate of Infection in Rheumatoid Arthritis Patients

2014 ◽  
Vol 4 (1) ◽  
pp. 15-21
Author(s):  
Aisha A. Al Ghamdi ◽  
Suzan M. Attar
Keyword(s):  
Rheumatoid Arthritis ◽  
University Hospital ◽  
Inflammatory Disorder ◽  
Risk Of Infection ◽  
Kingdom Of Saudi Arabia ◽  
Steroid Use ◽  
Increased Risk ◽  
King Abdulaziz University ◽  
Associated Risk Factors ◽  
Common Infections

Objectives: Rheumatoid arthritis is an autoimmune inflammatory disorder associated with increased risk of infection. The aim of this study was to evaluate infections frequency in rheumatoid arthritis patients and to report the independent associated risk factors. Methods: Rheumatoid arthritis patients (n = 200) were retrospectively reviewed at King Abdulaziz University Hospital Jeddah, Kingdom of Saudi Arabia from January 2008 to December 2010. The rate and predictors of infection were evaluated. Results: The frequency of infection in rheumatoid arthritis patients was (36%). The most common infections were pneumonia, bacteremia and urinary tract infection occurring in 18%, 12%, and 10%, respectively. The strongest and significant predictors for infection were cardiovascular disease (OR = 8.87), renal impairment (OR = 7.12), and steroid use (OR = 1.67). Conclusions: Infection rate in rheumatoid arthritis patients was high but lower than other studies. Comorbid illnesses (renal and cardiovascular diseases) and steroids in rheumatoid arthritis patients predisposed them to develop infections that may necessitate hospitalization. Comorbid illnesses should be managed early and steroids to be used cautiously in order to reduce infection risk among rheumatoid arthritis patients.

scholarly journals POS0053 RHEUMATOID ARTHRITIS AND THE RISK OF COVID-19 DIAGNOSIS, HOSPITALISATION AND DEATH: A POPULATION-BASED MULTI-STATE COHORT ANALYSIS INCLUDING 5,586,565 PEOPLE IN CATALONIA, SPAIN

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 232.1-232
Author(s):  
A. Vivekanantham ◽  
E. Burn ◽  
S. Fernandez-Bertolin ◽  
M. Aragon ◽  
T. Duarte-Salles ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Primary Care ◽  
General Population ◽  
Cohort Analysis ◽  
Population Based ◽  
Survival Models ◽  
Hazard Ratios ◽  
Increased Risk ◽  
And Gender ◽  
Training Programmes

Background:The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is of particular concern for people with rheumatoid arthritis (RA), with concerns that these people may be at higher risk and have poorer outcomes. However, at present the implications of COVID-19 for people with RA remain poorly understood.Objectives:To investigate the associations between rheumatoid arthritis and the risk of COVID-19 diagnosis, hospitalisation with COVID-19 and COVID-19-related death.Methods:A population-based cohort study including all individuals registered in the Information System for Research in Primary Care (SIDIAP). SIDIAP includes primary care records covering over 80% of the population of Catalonia, Spain, and was linked to region-wide SARS-CoV-2 PCR testing, hospital and mortality records. Outpatient diagnoses of COVID-19, hospitalisations with COVID-19 and deaths with COVID-19 were identified as study outcomes between 1st March and 6th May 2020. A multi-state model was used, with cause-specific Cox survival models estimated for each transition, adjusted for age and sex.Results:A total of 5,586,565 individuals were identified in SIDIAP as of the 1st March 2020, of which 16,344 had RA. RA patients were median (IQR) 63 years (52.0, 74.0) and the majority (n=11,727, 71.8%) were female. Having RA was positively associated with being diagnosed with COVID-19 (adjusted HR 1.14 (1.03 to 1.28)), with hospitalisation with COVID-19 (HR 1.66 (1.35 to 2.04)). However, we did not find an association between RA status and the risk of worsening from outpatient diagnosis to hospitalization or death, or from hospitalization to death (see Table 1).Table 1.Estimated hazard ratios, adjusted for age and gender, for individuals with rheumatoid arthritisTransitionStudy population (RA), nTotal events (RA), nHazard Ratios(95% Confidence Intervals)From general population to diagnosed with COVID-195,586,565 (16,344)88,396 (324)1.14 (1.03 to 1.28)From general population to hospitalised with COVID-195,586,565 (16,344)10,143 (90)1.66 (1.35 to 2.04)From diagnosed with COVID-19 to hospitalised with COVID-1988,396 (324)5,946 (30)0.95 (0.66 to 1.36)From diagnosed with COVID-19 to death88,396 (324)2,295 (16)0.96 (0.58 to 1.56)From hospitalised with COVID-19 to death16,089 (120)2,602 (27)1.13 (0.77 to 1.64)Conclusion:To our knowledge, this is the largest study performed to date looking at COVID-19 outcomes in RA patients. Individuals with RA were found to have an increased risk of COVID-19 diagnosis and hospitalisation with COVID-19, compared to the general population. Further research is needed to address factors associated with this including the presence of other co-morbidities, underlying RA disease activity and the use of immunosuppressive medications.Disclosure of Interests:Arani Vivekanantham: None declared, Edward Burn: None declared, Sergio Fernandez-Bertolin: None declared, Maria Aragon: None declared, Talita Duarte-Salles: None declared, Daniel Prieto-Alhambra Grant/research support from: Dr. Prieto-Alhambra reports grants and other from AMGEN, grants, non-financial support and other from UCB Biopharma, grants from Les Laboratoires Servier, outside the submitted work; and Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums, and Synapse Management Partners have supported training programmes organised by DPA’s department and open for external participants.

scholarly journals Patient experiences of using skin self-monitoring apps with people at higher risk of melanoma: a qualitative study (Preprint)

2020 ◽  
Author(s):  
Emily Habgood ◽  
Christopher McCormack ◽  
Fiona M Walter ◽  
Jon D Emery
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Early Detection ◽  
Secondary Care ◽  
Mobile Apps ◽  
Healthcare Providers ◽  
Structured Interview ◽  
Self Monitoring ◽  
Increased Risk ◽  
Data Saturation

BACKGROUND Melanoma is the 4th most commonly diagnosed cancer in Australia. Up to 75% of melanomas are first detected by patients or their family/friends. Many mobile apps for melanoma exist, including apps to encourage skin self-monitoring (SSM) to improve the likelihood of early detection. Previous research in this area has focused on their development, diagnostic accuracy, or validation. Little is known about patients’ views and experiences of using these apps. OBJECTIVE This study aims to understand patients’ views and experiences of using commercially available melanoma SSM mobile apps for a period of three months. METHODS This qualitative study was conducted in two populations: primary care (where the MelatoolsQ tool was used to identify patients who were at increased risk of melanoma) and in secondary care (where patients had a previous diagnosis of melanoma, stages 0-3a). Participants downloaded two of four mobile apps for SSM (SkinVision, UMSkinCheck, Mole Monitor or MySkinPal) and were encouraged to use them for three months. After three months, a semi-structured interview was conducted with participants to discuss their experiences of using the SSM mobile apps. RESULTS Fifty-four participants were recruited into the study with 20 (37%) from primary care and 34 (62%) from secondary care. Interviews were conducted with 34 participants when data saturation was reached. Most participants didn’t use the apps at all (n=12) or tried them once but didn’t continue (n=14). Only eight participants used the apps to assist with SSM for the whole duration of the study. Patients discussed the apps in the context of the importance of early detection and their current SSM behaviours. A range of features of ‘perceived quality’ of each app affected engagement to support SSM. Participants described their SSM routines and potential mismatch with the app reminders. They also described technical and practical difficulties experienced using the apps for SSM. The app’s positioning within existing relationships with healthcare providers was crucial to understand use of the apps. CONCLUSIONS This study of patients at increased risk of melanoma highlights several barriers to engagement with apps to support SSM. The results highlight the wide ranging and dynamic influences on engagement with mobile apps, which extend beyond app design and relate to broader contextual factors about SSM routines and relationships with healthcare providers.

Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment

2020 ◽  
Vol 18 (5) ◽  
pp. 431-446 ◽  
Author(s):  
George E. Fragoulis ◽  
Ismini Panayotidis ◽  
Elena Nikiphorou
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Current Evidence ◽  
Pharmacological Intervention ◽  
Cvd Risk ◽  
The Past ◽  
Increased Risk ◽  
Cv Disease ◽  
Obesity Hypertension ◽  
Inflammatory Burden

Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. Inflammation, however, can spread beyond the joints to involve other organs. During the past few years, it has been well recognized that RA associates with increased risk for cardiovascular (CV) disease (CVD) compared with the general population. This seems to be due not only to the increased occurrence in RA of classical CVD risk factors and comorbidities like smoking, obesity, hypertension, diabetes, metabolic syndrome, and others but also to the inflammatory burden that RA itself carries. This is not unexpected given the strong links between inflammation and atherosclerosis and CVD. It has been shown that inflammatory cytokines which are present in abundance in RA play a significant role in every step of plaque formation and rupture. Most of the therapeutic regimes used in RA treatment seem to offer significant benefits to that end. However, more studies are needed to clarify the effect of these drugs on various parameters, including the lipid profile. Of note, although pharmacological intervention significantly helps reduce the inflammatory burden and therefore the CVD risk, control of the so-called classical risk factors is equally important. Herein, we review the current evidence for the underlying pathogenic mechanisms linking inflammation with CVD in the context of RA and reflect on the possible impact of treatments used in RA.

scholarly journals Vulnerable adults in police custody

2019 ◽  
Vol 22 (1) ◽  
pp. 5-8
Author(s):  
Ian Cummins
Keyword(s):  
Design Methodology ◽  
Research Literature ◽  
Police Custody ◽  
England And Wales ◽  
Content Type ◽  
Increased Risk ◽  
Vulnerable Adults

Purpose The purpose of this paper is to discuss the recent National Appropriate Adult Network (NAAN) report on the role of the appropriate adult. Design/methodology/approach This paper is based on the NAAN report and a review of relevant policy and research literature. Findings There to Help 2 highlights that there are still significant gaps in the provision of appropriate adult schemes across England and Wales. These gaps potentially place vulnerable adults at increased risk. Originality/value This paper is a review of recent research.

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