EULAR: Inflammatory arthritis routine care should include self-management strategies
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Routine care for inflammatory arthritis should include self-management strategies that feature problem-solving, goal-setting and, if possible, cognitive behavioral therapy, according to new EULAR recommendations.
EULAR published the recommendations, which cover the implementation of self-management interventions in patients with inflammatory arthritis, in the Annals of the Rheumatic Diseases.
“These recommendations cover an important unmet need in the care of people living with Inflammatory Arthritis (IA) and highlight the beneficial effects of self-management and its components,” Elena Nikiphorou, MBBS/BSc(Hons), MRCP, MBBS, PGCME, MD(Res), FHEA, of King’s College London, told Healio Rheumatology. “They provide guidance on embedding self-management interventions into the routine clinical care of people with IA, advocating that more focus should be given to goals that are more meaningful to patients, in the context of their everyday lives.”
“Therefore, these recommendations have potential to improve the management of people with IA, encourage a more holistic approach to their care and empower and support patients through their journey,” she added.
To develop recommendations for implementing self-management interventions in inflammatory arthritis, EULAR formed a multidisciplinary taskforce of 18 members from 11 European countries. Members’ backgrounds and specialties included rheumatology, nursing, occupational therapy, psychology, self-management, exercise physiology and physiotherapy. The group also featured patient representatives who offered firsthand experiences with inflammatory arthritis.
Members of the task force conducted a systematic literature review and met twice — once face-to-face and once virtually — to discuss evidence, definitions and overarching principles. The recommendations themselves were drafted during the second meeting, with input from patient organizations’ best practice examples, and later approved through two rounds of voting.
In all, the task force approved three overarching principles and nine recommendations. According to the overarching principles, self-management “implies taking an active role in learning about one’s condition,” and in the process of shared decision-making. In addition, the task force established that self-efficacy has a “positive effect on various aspects of living with IA.” Lastly, the group stated that patient organizations “often provide valuable self-management resources and collaboration” among health care professionals.
The nine recommendations are:
- Providers should encourage patients to be active partners of the care team and inform them of professionals and patient organizations involved in all aspects of their care;
- Patient education should be the starting point of, and underpin all, self-management strategies;
- Self-management strategies that include problem-solving and goal-setting and, where relevant and possible, cognitive behavioral therapy, should be included in routine clinical practice;
- Providers should promote physical activity, starting at diagnosis, throughout the disease course;
- Patients should receive lifestyle advice based on evidence to better manage common comorbidities;
- Patients’ mental health should be assessed “periodically,” with appropriate interventions made available if necessary;
- Health professionals should initiate discussions about patients’ work, and “signpost” to helpful resources where appropriate;
- Digital health care options should be considered for inclusion in supported self-management, where appropriate and available; and
- Providers should educate themselves on the available resources that may help their patients.
“For self-management to be effective, it is imperative that health care professionals are given adequate guidance and professional training,” Nikiphorou said. “This can improve their engagement in clinical self-management support and patient centeredness, as well as their overall confidence to support self-management.”
“These recommendations provide guidance to health care professionals on how to embed self-management recommendations into routine clinical care,” she added. “Adherence to these recommendations has the potential to improve patient care and outcomes in people living with IA and encourage a more active patient role in the management of disease.”
Perspective
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Joni Fontenot, RN
In a clinical setting, developing a therapeutic rapport and trust with patients is so important. It aids in the overall outcome with patients and their compliance with their medication regimen.
Patients being an active participant in their care starts with health care teams educating patients on all aspects of their disease process from first encounters throughout the duration of their disease process. This goes beyond prescribing medications. Doing things such as explaining care, providing choices, providing emotional support, providing empathetic listening, encouraging questions, answering questions, providing reassurance and acknowledging patients’ thoughts and feelings all play a huge part in getting patients active and being more involved in their care outside the clinical setting.
As stated in the article, the promotion of physical activity, giving lifestyle advice, support with mental health and the ability for patients to remain at work, in addition to patients having a support system they can reach out to helps with the overall compliance of patients with their medication regimen and overall wellbeing.
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