A randomized study comparing regular care with a nurse‐led clinic based on tight disease activity control and person‐centred care in patients with rheumatoid arthritis with moderate/high disease activity: A 6‐month evaluation

• Published in: Musculoskeletal care 2019-09, Vol.17 (3), p.215-225
• Main Authors: Bergsten, Ulrika, Almehed, Katarina, Baigi, Amir, Jacobsson, Lennart T.H.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arthritis, Rheumatoid - therapy; Autoimmunitet och inflammation; Autoimmunity and Inflammation; Disease Management; Female; Humans; Male; Middle Aged; nursing; Nursing care; Patient-centered care; Practice Patterns, Nurses' - statistics & numerical data; Rheumatoid arthritis; self-management
• ISSN: 1478-2189; 1557-0681
• DOI: 10.1002/msc.1403

Introduction A recent survey showed that 27% of rheumatoid arthritis (RA) patients had inadequately controlled disease activity. Hence, there is a need for new strategies aiming at improving patient outcomes. The aim of the present study was to evaluate the effect of a nurse‐led clinic with frequent visits, treat‐to‐target and person‐centred care of patients with established RA and moderate‐to‐high disease activity compared with patients receiving regular care. Methods The study was a randomized, controlled trial over 26 weeks, with a nonrandomized extension to week 50. Patients were randomized to an intervention group (IG; nurse‐led clinic) based on person‐centred care, frequent visits and “treat to target”, or to a control group (CG) which visited the clinic according to care as usual. The primary outcome was the difference in the DAS28 change between the IG and the CG groups. Results A total of 332 patients were screened for eligibility, of which 70 were randomly assigned to either the IG (n = 36) or the CG (n = 34) group. The primary outcome was not met, although patients in the IG group tended to improve more than those in the CG group (difference: 0.43 (95% confidence interval [CI] –0.27, 1.13). In both the IG and CG groups, delta‐DAS28 improved significantly. The European League Against Rheumatology moderate or good response was achieved by 76% (95% CI 58, 89) in the IG and 49% (95% CI 32, 65) in the CG group. Conclusions Disease activity tended to improve more with the nurse‐led intervention compared with regular care, although the difference was not significant, probably partly due to the lack of statistical power.