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Randomized Controlled Trial
. 2019 Jun 14;5(2):e000914.
doi: 10.1136/rmdopen-2019-000914. eCollection 2019.

Screening for and management of comorbidities after a nurse-led program: results of a 3-year longitudinal study in 769 established rheumatoid arthritis patients

Laure Gossec  1   2 , Martin Soubrier  3 , Frantz Foissac  4 , Anna Molto  5   6 , Pascal Richette  7   8 , Catherine Beauvais  9 , Adeline Ruyssen-Witrand  10 , Aleth Perdriger  11 , Isabelle Chary-Valckenaere  12 , Gael Mouterde  13 , Emanuelle Dernis  14 , Liana Euller-Ziegler  15 , René-Marc Flipo  16 , Mélanie Gilson  17 , Sandrine Guis  18 , Xavier Mariette  19 , Sophie Pouplin  20 , Thierry Marhadour  21 , Thierry Schaeverbeke  22 , Christelle Sordet  23 , Françoise Fayet  3 , Maxime Dougados  5   6
Affiliations
Randomized Controlled Trial

Screening for and management of comorbidities after a nurse-led program: results of a 3-year longitudinal study in 769 established rheumatoid arthritis patients

Laure Gossec et al. RMD Open. .

Abstract

Background/purpose: Cardiovascular (CV) risk, cancer, infections and osteoporosis should be screened for in rheumatoid arthritis (RA). The objective was to assess 3-year effects of a nurse visit for comorbidity counselling.

Methods: This was an open long-term (3 years) extension of the Comorbidities and Education in Rheumatoid Arthritis 6-month randomised controlled trial in which patients with definite, stable RA were visiting a nurse for comorbidity counselling. Comorbidity status was assessed and nurses provided advice on screening and management, at baseline and 3 years later. A score was developed to quantify comorbidity screening and management: 0-100, where lower scores indicate better screening and management. The score was compared between baseline and 3-year assessment using a Wilcoxon test for paired data.

Results: Of the 970 recruited patients, 776 (80%) were followed-up at 2-4 years and 769 (79%) had available data for comorbidities at both time points: mean (±SD) age 58 (±11) years and mean disease duration 14 (±10) years; 614 (80%) were women, the mean Disease Activity Score 28 was 3.0±1.3, and 538 (70%) were receiving a biologic. At baseline, the mean comorbidity screening score was 36.6 (±19.9) and it improved at 3 years to 24.3 (±17.8) (p<0.0001), thus with a relative improvement of 33% (improvement of 12 points). CV risk screening, vaccination status and bone densitometry performance improved the most.

Conclusions: Comorbidity screening was suboptimal but improved notably over 3 years, after a nurse-led programme aiming at checking systematically for comorbidity screening and giving patient advice. This long-term efficacy pleads in favour of nurse-led interventions to better address comorbidities in RA.

Trial registration number: NCT01315652.

Keywords: cardiovascular disease; multidisciplinary team care; nursing; rheumatoid arthritis; vaccination.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flowchart of patient disposition in the COMEDRA trial and for the 3-year follow-up. COMEDRA, Comorbidities and Education in Rheumatoid Arthritis; M0, month 0; M6, month 6; RA, rheumatoid arthritis.
Figure 2
Figure 2
Comorbidity screening and prevention score. (A) Baseline score. (B) Three years follow-up score.
See this image and copyright information in PMC

References

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    1. Dougados M, Soubrier M, Perrodeau E, et al. . Impact of a nurse-led programme on comorbidity management and impact of a patient self-assessment of disease activity on the management of rheumatoid arthritis: results of a prospective, multicentre, randomised, controlled trial (COMEDRA). Ann Rheum Dis 2015;74:1725–33. 10.1136/annrheumdis-2013-204733 - DOI - PMC - PubMed
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