OP0137 Assessing the risk of ra patients for comorbid conditions through a structured nurse-led interview – the eriko study

Abstract

Background: Assessment of comorbidities in rheumatoid arthritis (RA) has proven to be difficult for the rheumatologist due to lack of time leading to considerable deficits. Nurse‐led programs on RA comorbidity management might solve this problem and have been reported to be beneficial.1 Methods: The cluster randomised multicentre study ERIKO longitudinally assessed the general health status of patients with RA in Germany applying a nurse‐led scoring algorithm for individual risk profiles (ERIKO‐Score). The ERIKO‐Score is a composite score evaluating the following risk factors: cardiovascular (CV) risk (ESC‐guideline), infection risk (RABBIT risk calculator), vaccination status (guideline), fracture risk (FRAX), tooth status (PSI), depression (PHQ‐9) and health‐related quality of life (hrQoL, RAID). The outcome was translated into a three‐level ordinal score defined by the categories low, intermediate or high risk with 0, 1 and 2 points, respectively. Afterwards the treating rheumatologist discussed the outcomes with the patient. The primary endpoint, the change in ERIKO‐Score between baseline and after one year of follow‐up as a consequence of the structured assessment (active arm) was assessed using a mixed model in order to account for a random centre effect. Furthermore, comorbidity management in the active arm versus expert guided assessment following standard of care (SOC, control arm) was evaluated using Fisher's exact test and the Cochran‐ Armitage trend test. Results: The analysis included 341 patients from 42 rheumatology centres with 210 patients in the active arm (mean disease duration 12.0 years (sd 8.8), mean DAS28 2.6 (sd 1.1)) and 131 patients in the control arm (mean disease duration 9.7 years (sd 7.4), mean DAS28 2.6 (sd 1.2)). After one year of follow‐up the structured assessment led to a significant mean decrease in total ERIKO‐Score by ‐0.45 (95% CI ranging from ‐0.67 to ‐0.23, p<0.001). This decrease was driven by an improvement in vaccination status, tooth status and depression risk. No difference in comorbidity management was detected between the structured assessment and SOC. At the end of follow‐up, the mean ERIKO‐Scores for both arms were 4.85 with 95% CIs ranging from 4.59 to 5.11 and 4.47 to 5.24 for the active arm and the control arm, respectively. A significant improvement in risk categorisation after one year of follow‐up was observed for vaccination status and depression risk with better outcomes in the active arm as compared to the control arm. Conclusions: A nurse‐led comorbidity risk assessment in rheumatology practices resulted in a significant improvement after one year of follow‐up. However, improvement was small and there was no benefit compared to expert‐opinion based SOC. In clinical routine, applying the ERIKO‐Score based on validated tools seems to be feasible. Nurse‐led comorbidity assessment seems to be able to reduce existing deficits.