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We have read with great interest the study from Llop et al which explored the interaction between gender, disease activity and comorbidities in spondyloarthritis (SpA).1 This study emphasised differences between both gender in the prevalence of comorbidities with SpA and illustrates how comorbidities have varying impacts on disease outcomes in both sexes.
As high burden of comorbidities both impacts on treatment strategies and outcome2 3 and requires a patient-centred multiprofessional programmes,4 5 European League against Rheumatism (EULAR) has proposed points to consider to efficiently screen for comorbidities.2 Systematic screening of comorbidities has been adapted to detect and manage selected comorbidities.3 Addressing smoking habits through health literacy improvement might therefore improve biological disease-modifying antirheumatic drugs adhesion and comorbidity care.
We conducted a prospective single-centre, observational, non-randomised, unblinded cohort study (CECIC approval, IRB: 5891, NCT05613712). Eligible patients were recruited by rheumatologists from the rheumatology outpatient clinic at Grenoble University Hospital from November 2016 to April 2022. Table 1 summarises study population characteristics, according to EULAR recommendations with patients’ characteristics3 to identify connectedness.
Baseline demographics according to compliance with recommendation at baseline
The objective of this study was to assess variables associated with the implementation of recommendations following comorbidity screening among patients with rheumatoid arthritis (RA), SpA or psoriatic arthritis (PsA) 12 months after the systematic screening (online supplemental table 1).
Supplemental material
A total of 1460 recommendations were made; 99.0% (482/487) patients had at least one recommendation. At 12 months, 23.3% (330/1414) of the recommendations remained unsatisfied: 20.9% regarding infection prevention, 18.35% regarding cardiovascular prevention, 24.6% for cancer screening and 44.6% for osteoporosis. Respectively, 27.9%, 24.9%, 26.6% and 44.6% of patients did not follow these recommendations, considered as non-compliant patients. This finding parallels the survey by McGlynn et al which analysed adhesion to 439 recommendations for healthcare in the USA.6 Mean percentage of adhesion was 55%, 95 CI (54% to 56%) and barely varied according to type of care (preventive, acute or chronic) and medical function (screening, diagnosis, treatment and follow-up). In this survey, women had higher rates of visits than men (319.9 vs 234.9 visits per 100 persons per year), which could explain a higher adhesion to doctor’s recommendation in women.
Data are expressed as mean (SD) for continuous outcome measure or number (percentage) for categorical outcome measure. A p value was determined by parametric tests (χ2 test and Student’s t-test for univariate analyses, logistic regression for multivariate analysis). Variables with a p<0.05 in the univariate analysis (ie, gender, smoking and number of recommendations) were integrated into a multivariate logistic regression. In case of missing information regarding adherence to the recommendation, the comorbidity screening recommendation was considered unfulfilled at 12 months. For other variables and for those lost to follow-up, we did not impute missing data.
Mean (SD) number of baseline recommendations was similar in male and female patients, respectively 3.9 (1.7) and 3.6 (1.9) recommendations/patient. Smokers had a significantly higher number of baseline recommendations with 4.7 (1.9) and 3.6 (1.7) recommendations/patient.
When omitting the response to the recommendation of smoking cessation, smokers had the same number of baseline recommendations as non-smokers with 3.7 (1.9) and 3.6 (1.7) recommendations/patient; smokers were not significantly less adherent to recommendation, OR 0.66 95% CI (0.42 to 1.04), p=0.07.
We found no difference according to disease (RA, SpA or PsA), age or disease-related outcome measure, whereas male patients were less likely to follow recommendations similarly to previous study.
Our study has some limitations. It mainly relied on medical-record documentation, which may lead to the highest false positive rates. Indeed, medical records falsely overestimate the quality of healthcare, especially rheumatism-related physical examination and diagnosis.7
Few studies investigated gender-specific adhesion to recommendations. They also reported gender differences in patients with chronic inflammatory rheumatic disease regarding disease and comorbidity characteristics,2 with a significant impact on health trajectories. Systematic review provides the opportunity to deliver relevant information with a high level of empathy. Gender studies suggested that females, as married female patients are undersupported in comparison to male counterparts, they are more motivated than men by empathic communication8 of healthcare professionals involved in the systematic review. A misunderstanding or lack of information could explain this gap between genders. However, improving the availability of information on rheumatic diseases and treatments has few impacts on beliefs and health trajectories.9
Supplemental material
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants and was approved by Comité de protection des personnes Sud-Est ICHU de SAINT-ETIENNE-HOPITAL DE BELLEVUE-25 Boulevard Pasteur (Reference number: 22.04002.000195). Participants gave informed consent to participate in the study before taking part.IRB: 5891, NCT05613712
Acknowledgments
Authors thank Dr Begum Forestier and Mrs. Réjane Gruel who designed and recorded the patient database.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
AL, RG and LV are joint first authors.
Contributors AL: substantial contributions to the conception, design of the work; the acquisition, analysis and interpretation of data for the work. Drafting the work and revising it critically for important intellectual content. Final approval of the version to be published. LV: substantial contributions to the conception the acquisition, analysis and interpretation of data for the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RG: substantial contributions to the conception, design of the work; the acquisition, analysis and interpretation of data for the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AB: substantial contributions to the conception, design analysis and interpretation of data for the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AB is the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Author note AI technology was not used in this manuscript.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.