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) , Gérard Chales (17, 18) , Emmanuelle Dernis , Pascal Richette (19, 20) , Xavier Mariette (21) , Francis Berenbaum (22, 23) , Jean Sibilia (24) , Philippe Ravaud (4)

1 CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
2 Hôpital Cochin [AP-HP]
3 Département rhumatologie
4 CRESS - U1153 - Equipe 5 : METHODS - Méthodes de l’évaluation thérapeutique des maladies chroniques
5 Department of Rheumatology
6 CHU Grenoble
7 Service de rhumatologie [CHU Rouen]
8 LILLE - Rhumatologie - Département de Rhumatologie
9 Département de Rhumatologie[Montpellier]
10 Service de rhumatologie
11 Service de rhumatologie
12 Service de Rhumatologie [CHU Pitié Salpêtrière]
13 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
14 EA2216 - Immunologie et Pathologie
15 CHU - BREST - Rhumato - CHRU Brest - Service de Rhumatologie
16 Service de Rhumatologie [CHRU Nancy]
17 Service de rhumatologie [Rennes] = Rheumatology [Rennes]
18 Foie, métabolismes et cancer
19 UFR Médicale
20 Fédération de rhumatologie
21 Régulation de la réponse immune, infection VIH-1 et autoimmunité
22 UMRS893 - Centre de Recherche Saint-Antoine
23 Service de rhumatologie [Saint-Antoine]
24 Immuno-Rhumatologie Moléculaire

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

Keywords: Aged; Antirheumatic Agents; Arthritis; Rheumatoid; cardiovascular disease; Comorbidity; Diabetes Mellitus; Disease Management; Dyslipidemias; Female; Fractures; Bone; Humans; Hypertension; Male; Middle Aged; Nurse's Practice Patterns; Nursing; Patient Outcome Assessment; Rheumatoid Arthritis; Self Care; Self-Examination; Smoking

Domains: Life Sciences [q-bio]

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, 2015, 74 (9), pp.1725--1733. ⟨10.1136/annrheumdis-2013-204733⟩. ⟨hal-01225510⟩