Background/Purpose:  In order to achieve treatment goals in patients with rheumatoid arthritis (RA), the guidance for “treatment to target (T2T) by measuring disease activity and adjusting therapy accordingly” was proposed.¹⁾ However, patients with RA also face various other problems such as side effects of drugs, psychological problems and issues of daily living. These problems cannot be resolved by doctors alone and, therefore, collaboration with medical staff, especially nurses, is essential. As a first step toward better rheumatic care, the nurses understanding of T2T is considered to be important.We evaluated the understanding and practice of T2T for nurses engaged in rheumatic care.

Methods:  This is a cross-sectional survey conducted in Japan. Registered nurses consulting patients with RA were selected randomly for this study between May and September 2013. A self-administered survey was carried out to check the understanding of T2T, DAS28 and patient guidance. A series of data analyses were performed based on the Wilcoxon rank sum test and Pearson chi-square.

Results:  103 nurses (one male and 102 female) were enrolled. While 19 (18.4%) of the nurses knew the concept of T2T precisely, 47 (45.6%) understood partially and 37 (35.9%) did not know it at all. In comparison with 37 nurses who did not know about T2T, 66 nurses who knew about T2T showed higher knowledge about DAS28 (p<0.0001). The ratio of experience of the DAS calculation was also statistically significantly higher in nurses with knowledge of T2T compared with those without T2T knowledge (p<0.0001). Nurses with thorough knowledge of T2T statistically significantly engaged in guidance of daily life (p=0.018), therapeutic agent (p<0.0001) and health care system (p=0.004) compared with those who did not. Regarding the explanation of RA, there is no statistically significant difference between nurses with and without the knowledge of T2T (p=0.126).

Nurses who did not know about T2T statistically showed a significant tendency to consider that doctors should assess patients’ joints scores compared with those with a thorough knowledge of T2T (p=0.045). However, both nurses agreed that the benefits of the assessment of joint scores by nurses is broadening nursing care and saves time for doctors and promotes awareness of the patients’ condition before consultation. Most nurses think that they can assess joint scores technically with sufficient training.

Conclusion:  This study indicates that understanding the concept of T2T is necessary to expand the role of nurses and to develop the technical knowhow for nurses involved in rheumatic care, leading to better QOL for patients with RA. [1] Smolen JS, et al. Ann Rheum Dis. 2010; 69: 631-7.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/survey-on-the-understanding-and-practice-of-t2t-for-nurses-engaged-in-medical-treatment-of-rheumatoid-arthritis/