Screening of Hyperlipidemia Among Patients With Rheumatoid Arthritis in the United States

Abstract

Objective. To determine the proportion of primary lipid screening among patients with rheumatoid arthritis (RA) and compare it with those among patients with diabetes mellitus (DM) and patients with neither RA nor DM, and to assess whether primary lipid screening varied according to the health care provider (rheumatologist versus nonrheumatologist).Methods. We analyzed claims data from US private and public health plans from 2006-2010. Eligibility requirements included continuous medical and pharmacy coverage for ≥12 months (baseline period) and >2 physician diagnoses and relevant medications to define RA, DM, RA and DM, or neither condition. Among the 330,695 eligible participants, we calculated the proportion with a lipid profile ordered during the 2 years following baseline. Time-varying Cox proportional hazard models were used to determine the probability of hyperlipidemia screening in participants with RA according to provider specialty.Results. More than half of the patients were ages 41-71 years. Among patients with RA (n = 12,182), DM (n = 62,834), RA and DM (n = 1,082), and those who did not have either condition (n = 167,811), the proportion screened for hyperlipidemia was 37%, 60%, 55%, and 41%, respectively. Patients with RA who visited a rheumatologist and a non-rheumatology clinician during follow-up had a 55% (95% confidence interval 1.36-1.78) higher screening probability than those who only visited a rheumatologist.Conclusion. Primary lipid screening was suboptimal among patients with RA. It was also lower for patients with DM and minimally different from the general population. Screening was higher for RA patients who received care from both a rheumatologist and a non-rheumatologist (e.g., primary care physician).

Views of primary care physicians and rheumatologists regarding screening and treatment of hyperlipidemia among patients with rheumatoid arthritis

“…Our findings suggest that engaging PCPs may yield the higher probability of achieving lipid testing as PCPs thought of this process as lying within their scope of practice. This is consistent with previous studies that demonstrated that screening was 55% higher in patients with RA who visited a PCP vs. visiting a rheumatologist only [9]. Patients with RA may want to engage in discussions with their rheumatologist about lipid testing due to the frequency of visits with the rheumatologist as part of RA medication surveillance.…”

“…Unfortunately, ours and others' previous work have shown that lipid assessment among patients with RA is as low as 37% [9][10][11]. Although the likelihood of cholesterol testing increases if patients are followed by both primary care providers (PCP) and rheumatologists [9,10], some RA patients do not see a PCP, decreasing the likelihood of cholesterol testing [9][10][11].…”

Derivation and internal validation of a multi-biomarker-based cardiovascular disease risk prediction score for rheumatoid arthritis patients

“…In addition, the “lipid paradox” [ 61 ] may make it difficult to interpret lipid values in RA patients, as they can be lower during active RA and increase with effective treatment. A practical consideration is that many RA patients have not had lipids tested recently, and co-management with primary care physicians may be needed to improve rates of screening for hyperlipidemia [ 62 ].…”

Burden and trajectory of multimorbidity in rheumatoid arthritis: a matched cohort study from 2006 to 2015

“…In RA, co-management with a primary care physician improves screening for hyperlipidaemia. 41 Alternative care delivery models that use case managers and multidisciplinary teams have been tested with heterogenous results in the general population. 42 Limitations of this study include the inability to adjust for health behaviours and sociodemographics, which may result in unmeasured confounding.…”