Impact of a nurse-led programme on comorbidity management and impact of a patient self-assessment of disease activity on the management of rheumatoid arthritis: results of a prospective, multicentre, randomised, controlled trial (COMEDRA)

Abstract

ObjectivesRheumatoid arthritis (RA) patients are at an increased risk of developing comorbid conditions. A close monitoring of the disease targeting a status of low disease activity is associated with a better outcome. The aim of this trial was to evaluate the impact of a nurse-led programme on comorbidities and the impact of patient self-assessment of disease activity on the management of RA.MethodsWe enrolled 970 patients (mean age 58 years, 79% women) in a prospective, randomised, controlled, open-label, 6-month trial. In the comorbidity group (n=482), the nurse checked comorbidities and sent the programme results to the attending physicians. In the self-assessment group (n=488), the nurse taught the patient how to calculate his/her Disease Activity Score which had to be reported on a booklet to be shared with the treating rheumatologist. The number of measures taken for comorbidities and the percentage of patients recording a change (initiation, switch or increased dose) in disease-modifying antirheumatic drugs (DMARDs) in the 6 months follow-up period of the study defined the outcomes of the trial.ResultsThe number of measures taken per patient was statistically higher in the comorbidity group: 4.54±2.08 versus 2.65±1.57 (p<0.001); incidence rate ratio: 1.78 (1.61–1.96) and DMARD therapy was changed more frequently in the self-assessment group: 17.2% versus 10.9% (OR=1.70 (1.17; 2.49), p=0.006).ConclusionsThis study demonstrates the short-term benefit of a nurse-led programme on RA comorbidity management and the impact of patient self-assessment of disease activity on RA treatment intensification.Trial registration numberNCT #01315652.

A multi-centre study of interactional style in nurse specialist- and physician-led Rheumatology clinics in the UK

“…Despite wide-scale adoption, evidence of the effectiveness of nurse specialists and their clinics is limited. Recent work has addressed this gap with two recent multi-centre studies undertaken in the UK of effectiveness and economic value [3] and, in France, of co-A c c e p t e d M a n u s c r i p t morbidity management [4]. Results provide robust evidence to support nurse-led clinics in the management of Rheumatoid Arthritis and co-morbidity detection with nurse-led clinics having higher 'general satisfaction' than physician-led clinics [5].…”

Comorbidities in rheumatoid arthritis

“…For example, the screening for risk factors of cardiovascular diseases performed by rheumatologists has been shown as feasible and useful, permitting the detection of predisposing factors such as high blood pressure and/or dyslipidemia in 9 and 15% respectively thanks to this initiative [56].…”

Application of the European Society of Cardiology, Adult Treatment Panel III and American College of Cardiology/American Heart Association guidelines for cardiovascular risk management in a French cohort of rheumatoid arthritis

“…COMEDRA is a multicenter French cohort study evaluating the impact of nurse-led program on the management of comorbidities in patients with RA [13]. The study included the report of pre-existing comorbidities, the presence of risk factors and the implementation of the recommendation for the detection and/or management of such comorbidities.…”