@article {Gossece000914, author = {Laure Gossec and Martin Soubrier and Frantz Foissac and Anna Molto and Pascal Richette and Catherine Beauvais and Adeline Ruyssen-Witrand and Aleth Perdriger and Isabelle Chary-Valckenaere and Gael Mouterde and Emanuelle Dernis and Liana Euller-Ziegler and Ren{\'e}-Marc Flipo and M{\'e}lanie Gilson and Sandrine Guis and Xavier Mariette and Sophie Pouplin and Thierry Marhadour and Thierry Schaeverbeke and Christelle Sordet and Fran{\c c}oise Fayet and Maxime Dougados}, title = {Screening for and management of comorbidities after a nurse-led program: results of a 3-year longitudinal study in 769 established rheumatoid arthritis patients}, volume = {5}, number = {2}, elocation-id = {e000914}, year = {2019}, doi = {10.1136/rmdopen-2019-000914}, publisher = {BMJ Specialist Journals}, 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{\textendash}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{\textendash}4 years and 769 (79\%) had available data for comorbidities at both time points: mean ({\textpm}SD) age 58 ({\textpm}11) years and mean disease duration 14 ({\textpm}10) years; 614 (80\%) were women, the mean Disease Activity Score 28 was 3.0{\textpm}1.3, and 538 (70\%) were receiving a biologic. At baseline, the mean comorbidity screening score was 36.6 ({\textpm}19.9) and it improved at 3 years to 24.3 ({\textpm}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}, URL = {https://rmdopen.bmj.com/content/5/2/e000914}, eprint = {https://rmdopen.bmj.com/content/5/2/e000914.full.pdf}, journal = {RMD Open} }