Objective To determine the effectiveness of nurse‐led consultations in patients with stable rheumatoid arthritis (RA) in Hong Kong. Methods The present work was a single‐center, randomized, open‐label, noninferiority trial. Patients who had rheumatoid arthritis (RA) with low disease activity (LDA) were randomized at a 1:1 ratio to attend a nurse‐led consultation or rheumatologist follow‐up visit for 2 years. The primary end point was the proportion of patients whose RA remained at LDA. Secondary end points included the proportion of patients with RA in disease remission and the scores recorded on the Leeds Satisfaction Questionnaire at 2 years, changes from baseline on the Disease Activity Score in 28 joints using the C‐reactive protein level (DAS28‐CRP), modified Sharp/van der Heijde score (SHS), Health Assessment Questionnaire disability index (HAQ DI), Short Form 36 (SF‐36) physical component score, and 19‐item Compliance Questionnaire for Rheumatology (CQR‐19) score. Results Among 280 patients who were randomized equally to either attend nurse‐led consultations or rheumatologist follow‐up visits, 267 patients completed the study. In the nurse‐led consultation and rheumatologist follow‐up groups, 92.1% and 91.4% patients, respectively, remained at LDA at 2 years. The 95% confidence intervals (95% CIs) of the adjusted treatment difference were within the predefined noninferiority margin in both the intention‐to‐treat analysis (95% CI 5.75, 7.15) and the per‐protocol analysis (95% CI 1.67, 7.47). Although the changes in DAS28‐CRP score over 2 years were significantly different between the 2 treatment groups (P < 0.001), there were no significant changes from baseline in SHS, HAQ DI, SF‐36 physical component scores, and CQR‐19 scores. At the end of the study, more patients expressed satisfaction with nurse‐led consultations. Conclusion Nurse‐led consultations were not inferior to rheumatologist follow‐up visits in patients with stable RA.

BackgroundThe waiting time for newly referred patients to the rheumatology clinic is approximately 24 months. The Rheumatology Nurse Rapid Access Triage Clinic aims to shorten the waiting time of patients suspected to have rheumatoid arthritis (RA). It is hoped that patients with active RA can be fast-tracked to commence earlier treatment for better disease control.ObjectivesTo validate if Rheumatology Nurses (RhN) can screen out patients with active RA for earlier treatment and to evaluate the level of agreement in RA diagnosis between RhN and rheumatologists.MethodsNewly referred patients suspected to have RA were assessed by RhN from March 2012 to September 2015. Based on a protocol modelled upon the 2010 European League Against Rheumatism (EULAR)/American College of Rheumatologists (ACR) criteria for the classification of RA, RhN performed history taking, physical examination of joints, and ordered relevant blood and X-ray investigations. RhN then reviewed all results to discriminate between RA and non-RA. Paired t-tests and logistic regression were used to compare variables between RA and non-RA patients diagnosed by RhN. Correlation coefficient (CC) was used to compare the level of agreement between RhN's and rheumatologists' assessment.ResultsRhN assessed 102 patients (mean age =53.46 ± 12.59 years, 84.3% women). The group diagnosed to have RA by RhN had shortened waiting time for the rheumatology clinic when compared to the non-RA group. (11.5 vs 3.6 months; p<0.001) Agreement between RhN diagnosed RA and rheumatologist diagnosed RA was excellent (CC 90%; P<0.001). Comparing with the non-RA group, RhN diagnosed RA group also had greater chance of receiving disease modifying anti-rheumatic drugs (DMARDs) early (OR 43.08, p<0.001). The mean duration between onset of joint symptom and DMARDs commencement was 8.26 ± 11.52 months ranging from 3 to 52 months.ConclusionsThe Rheumatology Nurse Rapid Access Triage Clinic provides accurate diagnosis and shortens RA patient's waiting time. It also helps to screen out active patients to receive earlier treatment.ReferencesGormley GJ, Steele WK, Gilliland A, Leggett P, Wright GD, Bell AL, Matthew C, Meenagh G, Wylie E, Mulligan R, Stevenson M, Reilly DO and Taggart AJ (2003) Can diagnostic triage by general practitioners or rheumatology nurses improve the positive predictive value of referrals to early arthritis clinics? Rheumatology 42:763–768.Disclosure of InterestNone declared