EULAR Report: Nurse-Led Care May Improve RA Patient-Reported Outcomes

Nurse-led care is non-inferior to rheumatologist-led care of patients with rheumatoid arthritis in regard to disease activity and patient reported outcomes, according to a German study presented at the European Congress of Rheumatology (EULAR) annual meeting.

“The results provide first evidence that nurse-led care could improve care and help carry the doctors’ workflow,” said KirstenHoeper, Ph.D., of the Hannover Medical School in Germany.

A shortage of care for patients with inflammatory rheumatic disorders may result in suboptimal reach of therapy objectives. However, such therapy objectives need to be achieved quickly in order to prevent permanent joint damage. Multidisciplinary teams, which include clinical nurse specialists, are required to ensure adequate care of patients with inflammatory rheumatic disorders. In addition to rheumatologists, clinical nurse specialists play an important role in improving standard-of-care, which ensures that essential medical provision remains intact. However, psychological, social, rehabilitative and educational requirements are often missed due to time constraints.

Published in RMD Open, the systemic review and meta-analysis found that there were no differences in disease activity between nurse-led and physician-led follow-up in patients with rheumatoid arthritis. No such studies have been published in Germany.

This prospective multi-centered study aimed to demonstrate the non-inferiority of nurse-led care to rheumatologist-led care for seropositive rheumatoid arthritis patients with induction, escalation or change of therapy regarding disease activity, as measured by Disease Activity Score-28 (DAS28), and several patient-reported outcomes.

A total of 236 patients (mean age 58 years) with rheumatoid arthritis were randomized to receive either nurse-led care (n=117, 72.4 percent female) or rheumatologist-led care (n = 119, 78.1 percent female). The primary outcome measure was disease activity (DAS28), which was assessed at baseline, at six weeks, and at three, six, nine and 12 months. Secondary outcomes were health related quality of life (Rheumatoid Arthritis Impact of Disease [RAID] score), functionality (Hanover Functional Ability Questionnaire [FFbH]), and depression (Patients Health Questionnaire-9 [PHQ9]).

DAS28 improved significantly over time (p < .001), but the interaction of DAS28 and the randomization was not significant, meaning that nurse-led care and rheumatologist-led care did not differ significantly. Meanwhile, RAID, FFbH and PHQ9 improved significantly over time, (p < .001 for all), and were also not affected by randomization.

“The results support the non-inferiority of nurse-led care in the management of RA regarding the primary and secondary outcome measures,” Dr. Hoeper said.

REFERENCE

OP0154-HPR (2020) Effect Of Nurse-Led-Care On Patient Outcomes In Rheumatoid Arthritis In Germany: A Multicentre Randomised Controlled Trial. KirstenHoeper, Ph.D. 2020 EULAR E-Congress