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Screening of Hyperlipidemia among Patients with Rheumatoid Arthritis in the United States

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Navarro-Millán I1,2, Yang S3, Chen L3, Yun H3, Jagpal A3, Bartels CM4, Fraenkel L5, Safford MM1, Curtis JR3. Arthritis Care Res (Hoboken). 2018 Nov 10. doi: 10.1002/acr.23810. [Epub ahead of print]


Author information 1 Weill Cornell Medicine, Division of General Internal Medicine, New York, NY. 2 Division of Rheumatology, Hospital for Special Surgery, New York, NY. 3 University of Alabama at Birmingham, Birmingham, AL. 4 University of Wisconsin, Madison, WI. 5 Yale University, New Haven, CT.

Abstract OBJECTIVE: To determine the proportion of primary lipid screening among patients with rheumatoid arthritis (RA) and compare it with patients with diabetes mellitus (DM) and patients with neither RA nor DM. To determine whether primary lipid screening varied according to the healthcare provider (rheumatologist vs. non-rheumatologist).

METHODS: We analyzed claims data from United States' private and public health plans from 2006-2010. Eligibility requirements included: 1) continuous medical and pharmacy coverage for ≥12 months (baseline period), and 2) >2 physician diagnoses and relevant medications to define 4 disease categories: 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: Over half the patients were 41-71 years old. Among patients with RA (n=12,182), DM (n=62,834), RA and DM (n=1,082), and neither 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% CI [1.36, 1.78]) higher screening probability than those who only visited a rheumatologist.

CONCLUSION: Primary lipid screening was suboptimal among RA patients. It was also lower than patients with DM and minimally different from the general population. Screening was higher for RA patients receiving care from both a rheumatologist and a non-rheumatologist (e.g. primary care physician).