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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)

Maxime Dougados 1, 2 Martin Soubrier 3 Elodie Perrodeau 4 Laure Gossec 5 Françoise Fayet Mélanie Gilson 6 Marie-Hélène Cerato Sophie Pouplin 7 René-Marc Flipo 8 Laurent Chabrefy Gaël Mouterde 9 Liana Euller-Ziegler 10 Thierry Schaeverbeke 11 Bruno Fautrel 12, 13 Alain Saraux 14, 15 Isabelle Chary-Valckenaere 16, 17 Gérard Chales 18, 19 Emmanuelle Dernis Pascal Richette 20, 21 Xavier Mariette 22 Francis Berenbaum 23, 24 Jean Sibilia 25 Philippe Ravaud 4
Abstract : OBJECTIVES: Rheumatoid arthritis (RA) patients are at an increased risk of developing comorbid conditions. A close monitoring of the disease targeting a status of low disease activity is associated with a better outcome. The aim of this trial was to evaluate the impact of a nurse-led programme on comorbidities and the impact of patient self-assessment of disease activity on the management of RA. METHODS: We enrolled 970 patients (mean age 58 years, 79% women) in a prospective, randomised, controlled, open-label, 6-month trial. In the comorbidity group (n=482), the nurse checked comorbidities and sent the programme results to the attending physicians. In the self-assessment group (n=488), the nurse taught the patient how to calculate his/her Disease Activity Score which had to be reported on a booklet to be shared with the treating rheumatologist. The number of measures taken for comorbidities and the percentage of patients recording a change (initiation, switch or increased dose) in disease-modifying antirheumatic drugs (DMARDs) in the 6 months follow-up period of the study defined the outcomes of the trial. RESULTS: The number of measures taken per patient was statistically higher in the comorbidity group: 4.54±2.08 versus 2.65±1.57 (p\textless0.001); incidence rate ratio: 1.78 (1.61-1.96) and DMARD therapy was changed more frequently in the self-assessment group: 17.2% versus 10.9% (OR=1.70 (1.17; 2.49), p=0.006). CONCLUSIONS: This study demonstrates the short-term benefit of a nurse-led programme on RA comorbidity management and the impact of patient self-assessment of disease activity on RA treatment intensification. TRIAL REGISTRATION NUMBER: NCT #01315652
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Submitted on : Friday, November 6, 2015 - 11:31:09 AM
Last modification on : Wednesday, October 14, 2020 - 4:15:01 AM

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Maxime Dougados, Martin Soubrier, Elodie Perrodeau, Laure Gossec, Françoise Fayet, 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). Annals of the Rheumatic Diseases, BMJ Publishing Group, 2015, 74 (9), pp.1725--1733. ⟨10.1136/annrheumdis-2013-204733⟩. ⟨hal-01225510⟩

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