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Rheumatoid arthritis
Original research
Considerations for improving quality of care of patients with rheumatoid arthritis and associated comorbidities
  1. Tore K Kvien1,
  2. Alejandro Balsa2,
  3. Neil Betteridge3,
  4. Maya H Buch4,5,
  5. Patrick Durez6,
  6. Ennio Giulio Favalli7,
  7. Guillaume Favier8,
  8. Cem Gabay9,
  9. Rinie Geenen10,
  10. Ioanna Gouni-Berthold11,
  11. Frank van den Hoogen12,13,
  12. Alison Kent14,
  13. Lars Klareskog15,
  14. Mikkel Ostergaard16,
  15. Karel Pavelka17,
  16. Joaquim Polido Pereira18,
  17. Anne Grete Semb1,
  18. Magnus Sköld19,20 and
  19. Maxime Dougados21
  1. 1Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  2. 2Hospital Universitario La Paz, Madrid, Spain
  3. 3Neil Betteridge Associates, London, UK
  4. 4Centre for Musculoskeletal Research, School of Biological Sciences, University of Manchester, Manchester, UK
  5. 5Leeds Institute of Rheumatic & Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK
  6. 6Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium
  7. 7Rheumatology, Gaetano Pini Institute, Milan, Italy
  8. 8Global Strategy Group, KPMG LLP, London, UK
  9. 9Department of Internal Medicine Specialties, University Hospitals of Geneva, Geneva, Switzerland
  10. 10Utrecht University, Utrecht, Netherlands
  11. 11University of Cologne, Koln, Germany
  12. 12Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
  13. 13Sint Maartenskliniek, Nijmegen, Netherlands
  14. 14Salisbury NHS Foundation Trust, Salisbury, UK
  15. 15Rheumatology, Karolinska Institutet, Stockholm, Sweden
  16. 16Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
  17. 17Rheumatologic Clinic, Institute of Rheumatology, Prague, Czech Republic
  18. 18Hospital De Santa Maria, Lisboa, Portugal
  19. 19Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
  20. 20Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden
  21. 21Hôpital Cochin, Rheumatology, Université Paris Descartes, Paris, France
  1. Correspondence to Tore K Kvien; t.k.kvien{at}medisin.uio.no

Abstract

Objective Rheumatoid 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.

Methods A 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.

Results Challenges 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.

Conclusion Learning 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.

  • Rheumatoid Arthritis
  • Arthritis
  • Autoimmune diseases
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/rmdopen-2020-001211

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    Footnotes

    • Contributors All authors contributed to the data collection, to the interpretation and analyses of the results and to the writing of the manuscript. All authors have read and approved the final version of the manuscript submitted on 29 May 2020.

    • 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 TKK has received fees for speaking and/or consulting from AbbVie, Biogen, Celltrion, Egis, Eli Lilly, Hikma, MSD, Mylan, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi and UCB and received research funding to Diakonhjemmet Hospital from AbbVie, BMS, MSD, Pfizer, Roche and UCB. AB has received Grant/research support, fees for consultancies or as a speaker for Abbvie, Pfizer, Novartis, BMS, Nordic, Sanofi-Genzyme, Sandoz, Lilly, UCB and Roche. NB has received fees for speaking and/or consulting from Amgen, Eli Lilly, Grunenthal, GSK, Heart Vlavle Voice, Janssen, Roche, Sanofi Genzyme and Sanofi Regeron. MHB has received fees for speaking and/or consulting from AbbVie, AstraZeneca, Bristol-Myers-Squibb, Chugai, Eli Lilly, Merck-Serono, Pfizer, Roche, Sandoz and Sanofi, and research funding to University of Leeds from Pfizer, Roche and UCB. PD has received fees for speaking and/or consulting from Bristol-Myers-Squibb, Celltrion, Lilly and Sanofi Genzyme. EGF has received fees for speaking and/or consulting from AbbVie, BMS, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Roche, Sanofi-Genzyme and UCB. CG has received fees for consulting from Roche, Sanofi Genzyme, Regeneron, Pfizer, Lilly and Ab2 Bio Ltd. RG has received fees for speaking from Sanofi Genzyme. IG-B has received fees for consulting from Amgen, Akcea, Sanofi Genzyme and Regeneron. FvdH has received fees for consulting from AbbVie, Biogen, Celltron, Roche, Sanofi Genzyme, Pfizer and Munidpharma. AK has received fees for speaking and/or consulting from UCB, Bristol-Myers-Squibb, MSD, Amgen, Abbvie, Pfizer, Novartis and Sanofi. LK has received research grants to Karolinska Institutet from Janssen, Pfizer, BMS, GSK and UCB. MØ has received fees for speaking and/or consulting from Abbvie, Bristol-Myers-Squibb, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merk, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sanofi and UCB. KP has received fees for speaking and/or consulting for AbbVie, Amgen, Biogen, Bristol-Myers-Squibb, Egis, MSD and UCB. JP-P has received fees for speaking and/or consulting from AbbVie, MSD, Pfizer, Roche and Tecnimede. AGS has received fees for speaking and/or consulting from AbbVie, Novartis, Sanofi and Bayer and have an unrestricted research collaboration with Eli Lilly which includes transfer of funds to Diakonhjemmet Hospital from Eli Lilly. MS has received research grants from Boehringer Ingelheim and Roche, speakers fee/consultancy from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Mundipharma, Sandoz and Roche. MD has received fees for speaking and/or consulting from AbbVie, Biogen, Eli Lilly, BMS, MSD, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB and his department has received research grants from AbbVie, BMS, MSD, Pfizer, Roche, Lilly, Janssen, Novartis and UCB.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available in a public, open-access repository. All data relevant to the study are included in the article or uploaded as online supplementary information.

    • Previous publications The main results were previously published as abstracts in ARD related to presentations at EULAR 2019: Kvien TK, Pavelka K, Polido-Pereira J, et al. THU0638 Considerations for improving quality of care in rheumatoid arthritis and associated comorbidities. Ann Rheum Dis. 2019;78 (suppl 2):A613; Betteridge N, Balsa A, Buch M, et al. PARE0018 Enabling patient-centred care in rheumatoid arthritis and associated comorbidities. Ann Rheum Dis. 2019;78 (suppl 2):A2185; Kent A, Gabay C, Geenen R, et al. AB1368-HPR enhanced role of nurses and other healthcare professionals (HCPs) in the care of rheumatoid arthritis and associated comorbidities. Ann Rheum Dis. 2019;78 (suppl 2):A2147. Further, the full report of the project has been published online: https://home.kpmg/content/dam/kpmg/uk/pdf/2020/02/improving-quality-of-care.pdf.