Nurse-led care for patients with rheumatoid arthritis was comparable to care led by rheumatologists and might have additional clinical benefits for pain control, disease activity and satisfaction, according to a recent British study.
Researchers from the Leeds Institute of Rheumatic and Musculoskeletal Medicine led a study tracking 181 adult rheumatoid arthritis patients to measure disease activity, pain and satisfaction. The results were published Aug. 27 on the website of the Annals of the Rheumatic Diseases.
Ninety-one patients were randomly assigned to receive care from a clinical nurse specialist, with 90 patients assigned to receive care from a rheumatologist. Both care groups included patients at varying disease levels. During the study period, patients were seen at 10 facilities across the U.K., and clinicians continued their normal practice.
Each patients disease activity score in 28 joints was assessed by an independent healthcare professional who did not know patients assignments. Patients were assessed at baseline and weeks 13, 26, 39 and 52 before meeting with their respective clinician.
Clinical nurse specialists had longer consultations with patients, a median of 20 minutes, compared with the physicians median of 15 minutes. All providers took a patients health history, did a physical exam and discussed pain control, including prescribing or recommending medication and dosage changes. Providers also educated the patients, discussed psychosocial support and ordered steroid injections, X-rays or blood tests as needed.
Although patients receiving nurse-led care had fewer medication changes and received fewer steroid injections and X-rays, they also showed better improvement in disease activity scores than those in the rheumatologist-led care group, the researchers found. Patients in the nurse-led care group also had fewer unplanned admissions or visits to the ED during the study. Clinical nurse specialists also provided patient education and psychosocial support more frequently than rheumatologists.
The findings provide evidence that nurse-led care is effective for rheumatoid arthritis patients with all levels of the disease, the researchers wrote, adding the results show possible benefits for overall disease activity and patient satisfaction.
This suggests that [nurse-led care] could manage most RA patients without loss of efficacy in terms of disease activity, the authors wrote.