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Rheumatoid arthritis
Original article
Screening for and management of comorbidities after a nurse-led program: results of a 3-year longitudinal study in 769 established rheumatoid arthritis patients
  1. Laure Gossec1,2,
  2. Martin Soubrier3,
  3. Frantz Foissac4,
  4. Anna Molto5,6,
  5. Pascal Richette7,8,
  6. Catherine Beauvais9,
  7. Adeline Ruyssen-Witrand10,
  8. Aleth Perdriger11,
  9. Isabelle Chary-Valckenaere12,
  10. Gael Mouterde13,
  11. Emanuelle Dernis14,
  12. Liana Euller-Ziegler15,
  13. René-Marc Flipo16,
  14. Mélanie Gilson17,
  15. Sandrine Guis18,
  16. Xavier Mariette19,
  17. Sophie Pouplin20,
  18. Thierry Marhadour21,
  19. Thierry Schaeverbeke22,
  20. Christelle Sordet23,
  21. Françoise Fayet3 and
  22. Maxime Dougados5,6
  1. 1Sorbonne Universite, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Paris, France
  2. 2Rheumatology, Pitie Salpetriere Hospital, AP-HP, Paris, France
  3. 3Rheumatology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
  4. 4Clinical Research Unit Necker-Cochin, Assistance Publique—Hopitaux de Paris, Paris, Île-de-France, France
  5. 5Rheumatology, Cochin Hospital, AP-HP, Paris, France
  6. 6INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris Descartes University, Paris, France
  7. 7Rheumatology, Lariboisiere Hospital AP-HP, Paris, France
  8. 8Inserm UMR1132 Bioscar, Universite Paris Diderot, Paris, France
  9. 9Rheumatology, Sorbonne Université and Hopital Saint-Antoine AP-HP, Paris, France
  10. 10Rheumatology, UMR 1027 Inserm, Paul Sabatier University and Purpan Hospital, Toulouse, France
  11. 11Rheumatology, South Hospital, Rennes 1 University, Rennes, France
  12. 12Rheumatology, Nancy University Hospital, Vandoeuvre les Nancy, France
  13. 13Immuno-rhumatologie, Lapeyronie Hospital and Montpellier University, Montpellier, France
  14. 14Rheumatology, Le Mans Hospital, Le Mans, France
  15. 15Rheumatology, University Hospital Pasteur 2, Nice, France
  16. 16Rheumatology, R Salengro Hospital, University of Lille, Lille, France
  17. 17Rheumatology, GREPI-CNRS, Grenoble Hospital and Université Joseph Fourier, Echirolles, France
  18. 18Rheumatology, University Hospital, AP-HM, Marseille, France
  19. 19Rheumatology, HôpitauxUniversitaires Paris-Sud, Université Paris-Sud, INSERM UMR1184, Le Kremlin Bicetre, France
  20. 20Rheumatology, Rouen University Hospital, Rouen, France
  21. 21Rheumatology, Cavale Blanche Hospital and INSERM 1227, Université Bretagne Occidentale, Brest, France
  22. 22Rheumatology, Pellegrin Hospital, Bordeaux University, CNRS 5164, Bordeaux, France
  23. 23Rheumatology, Hautepierre Hospital, Fédération de médecine translationnelle, UMR INSERM 1109, Strasbourg, France
  1. Correspondence to Pr Laure Gossec; laure.gossec{at}aphp.fr

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

  • rheumatoid arthritis
  • cardiovascular disease
  • nursing
  • vaccination
  • multidisciplinary team care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/rmdopen-2019-000914

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    Footnotes

    • Contributors All the authors except F Foissac, statistician, have provided data for the study; all the authors have participated in the data interpretation and have approved the final version.

    • Funding The initial COMEDRA trial was supported by the Roche France and a grant from the French National Research Program. This follow-up study was supported by a research grant from the French Ministry of Health (PHRC AOM 12072) and sponsored by the Département de la Recherche Clinique et du Développement del'Assistance Publique—Hôpitaux de Paris.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the French institutional review board, file #8-14 (ID RCB 2014-A00102-45).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available.