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.

Centre for Musculoskeletal Research School of Biological Sciences University of Manchester Manchester UK

Cliniques Universitaires Saint Luc UCL Brussels Belgium

Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Rigshospitalet Kobenhavn Denmark

Department of Internal Medicine Specialties University Hospitals of Geneva Geneva Switzerland

Department of Respiratory Medicine and Allergy Karolinska University Hospital Solna Karolinska Institutet Stockholm Sweden

Dept of Rheumatology Diakonhjemmet Hospital Oslo Norway

Global Strategy Group KPMG LLP London UK

Hôpital Cochin Rheumatology Université Paris Descartes Paris France

Hospital De Santa Maria Lisboa Portugal

Hospital Universitario La Paz Madrid Spain

Leeds Institute of Rheumatic and Musculoskeletal Medicine Chapel Allerton Hospital Leeds UK

Neil Betteridge Associates London UK

Radboud University Medical Center Nijmegen Nijmegen Netherlands

Respiratory Medicine Unit Department of Medicine Solna and Center for Molecular Medicine Karolinska Institutet Stockholm Sweden

Rheumatologic Clinic Institute of Rheumatology Prague Czech Republic

Rheumatology Gaetano Pini Institute Milan Italy

Rheumatology Karolinska Institutet Stockholm Sweden

Salisbury NHS Foundation Trust Salisbury UK

Sint Maartenskliniek Nijmegen Netherlands

University of Cologne Koln Germany

Utrecht University Utrecht Netherlands

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Nat Rev Rheumatol. 2020 Nov;16(11):607-608. doi: 10.1038/s41584-020-00504-y. PubMed

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