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)

• Published in: Annals of the rheumatic diseases Vol. 74; no. 9; pp. 1725 - 1733
• Main Authors: Dougados, Maxime, Soubrier, Martin, Perrodeau, Elodie, Gossec, Laure, Fayet, Françoise, Gilson, Mélanie, Cerato, Marie-Hélène, Pouplin, Sophie, Flipo, René-Marc, Chabrefy, Laurent, Mouterde, Gael, Euller-Ziegler, Liana, Schaeverbeke, Thierry, Fautrel, Bruno, Saraux, Alain, Chary-Valckenaere, Isabelle, Chales, Gérard, Dernis, Emmanuelle, Richette, Pascal, Mariette, Xavier, Berenbaum, Francis, Sibilia, Jean, Ravaud, Philippe
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.09.2015; BMJ Publishing Group
• Series: Extended report
• Subjects: Aged; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - epidemiology; Arthritis, Rheumatoid - therapy; Cancer therapies; Clinical and Epidemiological Research; Comorbidity; Diabetes Mellitus - epidemiology; Disease; Disease Management; Dyslipidemias - epidemiology; Female; Fractures, Bone - epidemiology; Humans; Hypertension - epidemiology; Influenza; Informed consent; Intervention; Life Sciences; Male; Medical screening; Middle Aged; Mortality; Nurses; Osteoporosis; Patient Outcome Assessment; Patients; Practice Patterns, Nurses; Remission (Medicine); Rheumatoid arthritis; Rheumatology; Risk factors; Self Care - methods; Self evaluation; Self-Examination - methods; Smoking - epidemiology; Cardiovascular Disease; Rheumatoid Arthritis; Nursing; Rheumatoid; Hypertension; cardiovascular disease; Dyslipidemias; Comorbidity; Humans; Middle Aged; Antirheumatic Agents; Male; Arthritis; Patient Outcome Assessment; Diabetes Mellitus; Nurse's Practice Patterns; Fractures; Female; Aged; Disease Management; Bone; Self-Examination; Self Care; Smoking
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2013-204733

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.