Background/Purpose:
Patients with chronic inflammatory arthritis (CIA) treated with anti-TNF therapy are usually followed up by rheumatologists. Nurse-led rheumatology clinics have been proposed for patients with low disease activity or in remission. The purpose of this trial was to compare treatment outcomes from a nurse-led rheumatology clinic and a rheumatologist clinic for patients undergoing anti-TNF therapy with low disease activity or in remission.
Methods:
A randomized controlled trial (RCT) with a 12-month follow-up was conducted with 107 patients randomised into two groups with a 6-month follow up to a nurse-led rheumatology clinic based on a person-centred care (intervention group; n=53) or to a rheumatologist-led clinic (control group; n=54). The intention of the interventional trial was to replace one of the two annual rheumatologist monitoring visits by a nurse-led rheumatology monitoring visit for patients undergoing anti-TNF therapy. Inclusion criteria were patients undergoing anti-TNF therapy and Disease Activity Score 28 (DAS28) ≤3.2. The hypothesis was that the outcomes from nurse-led clinic will not be inferior to those obtained by rheumatologist-led clinic at 12-month follow-up. Primary outcome was disease activity measured by DAS28.
Results:
After 12 months 47 patients in the intervention group and 50 patients in the control group completed the trial and there were no differences (p=0.66) in mean change of DAS28 between the intervention or control group. There were no differences (p>0.05) in mean change in Visual Analogue Scales (VAS) for pain, Health Assessment Questionnaire (HAQ), satisfaction or security with the rheumatology care between the two groups, see table.
Table. Mean difference of changes after 12 months between intervention group (Nurse-led rheumatology clinic) (n=47) and control group (Rheumatologist-led clinic) (n=50).
|
Nurse-led rheumatology clinic – Rheumatologist-led clinic |
||
|
Mean difference of changes (Std Error Difference) |
p |
|
|
DAS28 (mean) |
-0.06 (0.14) |
0.66 |
|
ESR (mm/h) |
-1.05 (1.47) |
0.47 |
|
Swollen joints (28) |
0.13 (0.24) |
0.60 |
|
Tender joints (28) |
0.33 (0.40) |
0.42 |
|
Global Health VAS (mm) |
4.29 (3.46) |
0.22 |
|
HAQ |
0.02 (0.06) |
0.79 |
|
Pain VAS (mm) |
-0.24 (3.85) |
0.95 |
|
student t-test |
||
Conclusion:
In monitoring of anti-TNF therapy treatment outcomes for patients at a nurse-led rheumatology clinic are not inferior to those obtained by rheumatologist-led clinic at 12-month follow-up. The follow-up care of anti-TNF therapy may advantageously be performed by a nurse-led clinic based on a person-centred care. The results from this trial demonstrated that patients with CIA undergoing anti-TNF therapy, with low disease activity or in remission, could be monitored by a nurse-led rheumatology clinic without any differences in outcome as measured by DAS28.
Disclosure:
I. Larsson,
None;
B. Fridlund,
None;
B. Arvidsson,
None;
A. Teleman,
None;
S. Bergman,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-outcomes-from-a-nurse-led-rheumatology-clinic-in-monitoring-of-anti-tnf-therapy-a-randomised-controlled-trial/