Résumé
BackgroundPatients with inflammatory rheumatisms especially rheumatoid arthritis (RA) have a greater risk of cardiovascular events, infections, lung diseases and osteoporosis. European League Against Rheumatisms (EULAR) recommends annual evaluation of the cardiovascular risks.ObjectivesA program of comorbidity screening in chronic diseases was set up in Languedoc-Roussillon (MACVIA-LR) as part of the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA). Chronic inflammatory rheumatisms are one of the target diseases.MethodsThis screening was set up in a daily clinic of our Rheumatology department. The assessment includes 1) rheumatism evaluation by doctors, nurses and physiotherapists; 2) cardiovascular evaluation including clinical examination, blood tests, modified systematic coronary risk evaluation (mSCORE) calculation, vessel ultrasound and echocardiography, 3) lung evaluation including self-questionnaires, spirometry ± chest X-ray; 4) osteoporosis including bone mineral density and FRAX calculation, and 5) check-up of vaccinal status and the recommended neoplasic screenings.Results92 patients already benefited from this systematic screening with 83% (n=76) of RA, 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. Thus, 25.3% and 20% of the patients were obese or overweight, respectively; 27.5% were active smokers and 21.7% were already treated for arterial hypertension. 59.8% of the patients received physiotherapy or occupational therapy advise for the management of their rheumatism. 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.ConclusionsA daily hospitalization for comorbidity screening seems worthy with significant abnormalities such as hypertension, diabetes, dyslipidemia or osteoporosis to treat 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 during this screening are under evaluation.Disclosure of InterestNone declared