Evaluating the impact of a rheumatologist-led comorbidity review in patients with inflammatory arthritis

OBJECTIVES: Patients with inflammatory arthritis (IA), including rheumatoid arthritis (RA) and spondyloarthritis (SpA), face elevated comorbidity risk, yet systematic comorbidity management is often inconsistent. This study evaluated baseline compliance with comorbidity management recommendations and assessed the clinical impact of a structured rheumatologist-led comorbidity review in routine care. METHODS: We conducted a retrospective cohort study of adults with RA or SpA who underwent one (n=458) or two (n=63) standardized reviews at a tertiary care hospital between June 2017-March 2025. The review followed EULAR and local guidelines. Cardiovascular and cancer screening recommendations were communicated to the general practitioner, while vaccinations and bone health prescriptions were provided directly. Descriptive statistics summarized patient characteristics and actions taken; adherence to recommendations before and after the first review was compared in those patients who participated in two reviews. RESULTS: Baseline care gaps were common: elevated LDL (44.6%), vitamin D deficiency (75.1%), and low vaccination rates (influenza 54.0%, DTP 55.7%). Following the review, 62.5% received vaccine prescriptions and 5.6% were referred to cardiology. Among patients with two reviews, significant improvements occurred in vitamin D deficiency (82.0% to 42.0%, P<0.001), influenza vaccination (42.1% to 68.4%, P=0.003), DTP vaccination (57.4% to 75.4%, P=0.035), and dermatology screening for skin cancer (45.2% to 58.1%, P=0.039). Cardiovascular risk factors remained largely unchanged. CONCLUSION: Rheumatologist-led comorbidity reviews can improve care in IA, particularly for interventions allowing direct action. Persistent gaps in cardiovascular risk management highlight the need for integrated pathways with primary care or specialist services to improve outcomes.