Nurse‐Led Consultation for Patients With Rheumatoid Arthritis at Low Disease Activity: A Randomized Noninferiority Trial

Abstract

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.

Adherence to Subcutaneous Anti-Tumour Necrosis Factor Treatment in a Cohort of Patients with Rheumatoid Arthritis Before and After the Implementation of a Comprehensive Care Model

“…27 Also, the CQR19 has been used in different rheumatology settings when evaluating RA patients, as applied by rheumatologist, implemented in teleconsultation, and applied by nurses. [28][29][30] On the other hand, the properties of treatment regimen, such as adverse events, dose, frequency, and route of administration, also influence adherence. 21,22 In this study, patients treated with Golimumab, administered monthly, showed greater adherence at the end of follow-up, unlike those treated with weekly (Etanercept) and every 2 weeks (adalimumab) administration regimens.…”

Nurse-supported care versus rheumatologist-led care in patients with rheumatoid arthritis at high disease activity: A retrospective study of two Chinese centers

“…Individuals the age of 18 years or more and who met the 2010 ACR-EULAR classification criteria for rheumatoid arthritis [ 12 ] that defined as DAS28-CRP more than 5.1 for a 6-month or more period were included in the study.…”

“…In China, rheumatology nursing service is not widely adopted because the feasibility and quality of rheumatology nursing service as part of a multidisciplinary team have not been confirmed in the Chinese population by the Chinese authorities. [12] The objectives of the retrospective study were to compare 2.5 years clinical outcomes of patients of rheumatoid arthritis with high disease activity (disease activity score 28-joint count with C-reactive protein (DAS28-CRP) more than 5.1) who received nurse-led care (nurse-supported care) against those of patients who received rheumatologist-led care for control of rheumatoid arthritis besides pharmacological treatments.…”

“…In China, rheumatology nursing service is not widely adopted because the feasibility and quality of rheumatology nursing service as part of a multidisciplinary team have not been confirmed in the Chinese population by the Chinese authorities. [ 12 ]…”

Nurse‐led care for people with early rheumatoid arthritis: Interview study with thematic analysis

“…Research has shown that nurse‐led care is just as effective as rheumatologist‐led care for managing RA. This is based on randomised controlled trials (RCTs) comparing consultations provided by rheumatology nurse specialists to consultations provided by rheumatologists (Beauvais et al., 2022; Hoeper et al., 2021; Koksvik et al., 2013; Kwok et al., 2022; Larsson et al., 2014; Lopatina et al., 2021; Ndosi et al., 2014; Primdahl et al., 2014; Sørensen et al., 2015). The RCTs found that patients who received nurse‐led care were more satisfied with their care and had similar health outcomes as patients who received care from a rheumatologist (Bech et al., 2020; de Thurah et al., 2017; Garner et al., 2017; Sezgin and Bektas, 2021).…”