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; Martin Soubrier; Elodie Perrodeau; Laure Gossec; Françoise Fayet; Mélanie Gilson; Marie-Hélène Cerato; Sophie Pouplin; René-Marc Flipo; Laurent Chabrefy; Gaël Mouterde; Liana Euller-Ziegler; Thierry Schaeverbeke; Bruno Fautrel; Alain Saraux; Isabelle Chary-Valckenaere; Gérard Chales; Emmanuelle Dernis; Pascal Richette; Xavier Mariette; Francis Berenbaum; Jean Sibilia; Philippe Ravaud

doi:10.1136/annrheumdis-2013-204733

Journal articles

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

UPD5 - Université Paris Descartes - Paris 5, CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité

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

18 Foie, métabolismes et cancer

19 UFR Médicale

20 Fédération de rhumatologie

21 Régulation de la réponse immune, infection VIH-1 et autoimmunité

22 CR Saint-Antoine - Centre de Recherche Saint-Antoine

23 Service de rhumatologie [Saint-Antoine]

24 Immuno-Rhumatologie Moléculaire

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

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

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Submitted on : Friday, November 6, 2015 - 11:31:09 AM
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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)

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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)

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