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Nurse-led programs effective for patients to self-manage RA
Nurse-led programs for patients with rheumatoid arthritis provided short-term benefits in patients’ self-management of disease activity and management of comorbidities associated with the disease, according to two analyses from a study presented at the annual congress of the European League Against Rheumatism in Madrid.
In a prospective, randomized controlled, open 6-month trial, researchers in France assigned 980 consecutive patients (active disease, n=488; controls, n=482) attending 20 rheumatoid arthritis (RA) clinics to one of two COMEDRA study arms. The first evaluated nurse-led programs on patients’ self-management; the second assessed management of comorbidities, including cardiovascular disease, osteoporosis, cancer or infection.
“Treat to Target and EULAR recommendations suggest that we should be promoting self-management skills so that patients can regularly assess their own disease activity,” investigator Maxime Dougados, MD, rheumatology professor, René Descartes University, Cochin Hospital, in Paris, said in a press release.
Eighty-nine percent of patients who received nurse-led training — including video interpreting of Disease Activity Score 28-ESR, guidance on self-joint assessment and protocol to report results to their treating rheumatologist — completed self-assessments and calculated their DAS within 6 months of study inclusion. Patients then shared their results with their treating rheumatologist, resulting in 17.2% of them changing their disease-modifying antirheumatic drug therapy compared with 10.9 % of controls (P=.0012).
“These data demonstrate that in the short term, nurse-led interventions can equip patients with the tools required to more effectively manage their disease,” Dougados said. “Longer-term patient follow-up is required to investigate the sustainability of these benefits, but these data have the potential to significantly alter the management of RA.”
In the study’s second arm, nurse-trained patients showed a significantly higher number of actions taken after 6 months designed to reduce their comorbidities (P<.0001). They included patients with cardiovascular disease initiating lipid-lowering or anti-platelet therapies, weight loss programs and smoking cessation (IRR=1.44; 95% CI, 1.30-1.61).
For patients with infections, vaccinations for hepatitis, influenza and pneumonia were received (IRR=1.78; 95% CI, 1.45-2.19); for cancer patients, mammographies, colonoscopies and other screening procedures were conducted (IRR=1.65; 95% CI, 1.42-1.92). When osteoporosis was a comorbidity, patients underwent dual energy X-ray absorptiometry, increased their calcium intake and/or were assigned osteoporotic medications (IRR=3.43; 95% CI, 2.88-4.13).
Laure Gossec
“Patients with RA are at an increased risk of developing a number of comorbid conditions,” Laure Gossec, MD, PhD, associate professor of rheumatology, Pierre-and-Marie-Curie University and Pitié-Salpétrière Hospital, in Paris, said in the release. “The number of actions undertaken to prevent these comorbidities was significantly greater in the arm where nurses had thoroughly assessed the risks.”
For more information:
Dougados M. OP0284: Impact of a Nurse-Led Program on Patient Self-Assessment of Disease Activity on the Management of Rheumatoid Arthritis (RA). Results of a Prospective, Multicenter, Randomized, Controlled Trial (COMEDRA). Presented at: EULAR 2013; June 12-15, Madrid.
Soubrier M. OP0234: Impact of a Nurse-Led Program on the Management of Comorbidities in Rheumatoid Arthritis (RA). Results of a Prospective, Multicenter, Randomized, Controlled Trial (COMEDRA). Presented at: EULAR 2013; June 12-15, Madrid.