Challenges of cardiovascular risk assessment in the routine rheumatology outpatient setting: an observational study of 110 rheumatoid arthritis patients.

OBJECTIVE: An annual assessment of cardiovascular (CV) risk factors in rheumatoid arthritis (RA) is recommended, but its practical modalities have not been determined. The objective was to assess the feasibility and usefulness of a standardized CV risk assessment in RA, performed by rheumatologists during outpatient clinics. METHODS: We used a cross-sectional design within a network of rheumatologists. Each rheumatologist included 5 consecutive unselected patients with definite RA. Data collection included standardized assessment of CV risk factors: blood pressure, interpretation of glycemia and of lipid levels, and calculation of the Framingham CV risk score. Outcome criteria included feasibility (missing data and time taken to assess the patients) and usefulness (the CV risk assessment was considered useful if at least 1 modifiable and previously unknown CV risk factor was evidenced). RESULTS: Twenty-two rheumatologists (77% in office-based practice) assessed 110 RA patients. The mean ± SD age was 57 ± 10 years, and the mean ± SD RA duration was 11 ± 9 years; 50 patients (45%) were treated with biologic agents, and 76% were women. Regarding feasibility, missing data were most frequent for glycemia (27% of patients) and cholesterolemia (14% of patients). The mean ± SD duration of the CV risk assessment was 15 ± 5 minutes. The CV risk assessment was considered useful in 33 patients (30%), evidencing dyslipidemia (15% of patients) or high blood pressure (9% of patients) as the most frequently previously unknown CV risk factor. CONCLUSION: The assessment of CV risk factors is feasible, but labor intensive, during an outpatient rheumatology clinic. This assessment identified modifiable CV risk factors in 30% of the patients. These results suggest that RA patients are not sufficiently assessed and treated for CV risk factors.

Floctafenin versus acetaminophen for pain control in patients with osteoarthritis in the lower limbs. Franco-Belgian Task Force.

A multicenter, double-blind, cross-over, random-order study compared the efficacy of floctafenin, 800 mg/day and acetaminophen, 3000 mg/day, in providing pain relief to 192 patients with chronic pain due to osteoarthritis in the lower limbs. Each drug was given for 12 days and the interval between the two treatment periods was two days. The primary evaluation criterion was pain relief as assessed using the visual analog scale developed by Huskisson (mean baseline score, 62.7 +/- 13.6 mm). Secondary criteria were the algofunctional index, the investigator's overall efficacy rating and patient preference. Floctafenin therapy was associated with significantly better results regarding the visual analog scale score (P = 0.036, 149 patients in the per protocol analysis) and the investigator's overall efficacy rating (P = 0.0001, 169 evaluable patients). Among the 169 evaluable patients, 68 had no preference for either treatment and 101 had a preference, which was for floctafenin therapy in 65% of cases (P = 0.001). Clinical tolerance was satisfactory with both drugs. Gastrointestinal symptoms were the most common side effects (13% and 11% of patients with floctafenin and acetaminophen, respectively).