Background/Purpose:
Patients with rheumatoid arthritis (RA) are at an increased risk of developing numerous comorbid conditions that affect both mortality and RA outcome.
Objectives: To evaluate the impact of a nurse-led program on comorbidity (cardiovascular disease [CVD], infection, cancer and osteoporosis) management in RA.
Methods:
Design: Prospective, randomized, controlled, open-label, six-month trial between March 2011 and December 2012
Setting: Outpatient clinic
Participants: Patients aged 18 to 80 years with non-active RA for at least three months (ACR criteria)
Intervention: After written informed consent was obtained, the study treatment was randomly allocated (i.e. either comorbidity evaluation by a nurse or using a self-assessment program). Study treatment: Data was collected by a nurse as recommended by the French Society of Rheumatology (SFR). In the event of inconsistencies, the patient was informed. A report summarizing the program results was prepared by the nurse and sent to the patient’s attending physician and rheumatologist.
Outcome variables: Number of actions taken for comorbidities, in line with the recommendations, in the six months following the program. The actions taken into account for CVD were: introduction of lipid-lowering or anti-platelet therapy, smoking cessation, blood pressure measurement, purchase of a sphygmomanometer, weight loss, creatinine measurement, nephrological consultation; for infection: vaccinations; for cancer: mammography, Pap smears, digital rectal examination and/or consultation with a urologist, fecal occult blood testing, colonoscopy and consultation with a dermatologist; and for osteoporosis: DEXA scan, increased alimentary calcium uptake, initiation of calcium and/or vitamin D supplementation and/or anti-osteoporosis medication, Increased physical activity and alcohol discontinuation.
Results:
The 970 recruited patients, 488 of whom were assigned to the active group and 482 to the control group, did not differ in terms of baseline characteristics. During the six-month follow-up, the number of actions taken per patient was statistically higher in the comorbidity group: 4.54+2.08 vs. 2.65+1.57 (p<0.001); incidence rate ratio (IRR): 1.78 (1.61–1.96). This increase in actions taken concerned CVD (IRR: 1.44 [1.30–1.61]), infection (IRR 1.81 [1.43–2.30]), cancer (IRR: 1.65 [1.40–1.94]) and osteoporosis (IRR 3.45 [2.91–4.09]).
Conclusion:
This study demonstrates the short-term benefit of a nurse-led program on RA comorbidity management.
Trial registration: NCT #0131652
Disclosure:
M. Soubrier,
None;
E. Perrodeau,
None;
M. Gilson,
None;
A. G. Cantagrel,
None;
X. le Loet,
None;
R. M. Flipo,
None;
S. Guis,
None;
G. Mouterde,
None;
L. E. Euller-Ziegler,
None;
T. Schaeverbeke,
None;
B. Fautrel,
None;
A. Saraux,
None;
I. Chary-Valckenaere,
None;
G. Chales,
None;
E. Dernis,
None;
P. Richette,
None;
X. Mariette,
None;
F. Berenbaum,
None;
J. Sibilia,
None;
P. Ravaud,
None;
M. Dougados,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-a-nurse-led-program-on-comorbidity-management-in-rheumatoid-arthritis-ra-results-of-a-prospective-multicenter-randomized-controlled-trial/