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)

被引：120

作者：

Dougados, Maxime ^{[1
,2
]}

Soubrier, Martin ^{[3
]}

Perrodeau, Elodie ^{[4
]}

Gossec, Laure ^{[5
]}

Fayet, Francoise ^{[3
]}

Gilson, Melanie ^{[6
]}

Cerato, Marie-Helene ^{[7
]}

Pouplin, Sophie ^{[8
]}

Flipo, Rene-Marc ^{[9
]}

Chabrefy, Laurent ^{[10
]}

Mouterde, Gael ^{[11
]}

Euller-Ziegler, Liana ^{[12
]}

Schaeverbeke, Thierry ^{[13
]}

Fautrel, Bruno ^{[14
]}

Saraux, Alain ^{[15
,16
]}

Chary-Valckenaere, Isabelle ^{[17
]}

Chales, Gerard ^{[18
]}

Dernis, Emmanuelle ^{[19
]}

Richette, Pascal ^{[20
,21
]}

Mariette, Xavier ^{[22
]}

Berenbaum, Francis ^{[23
,24
]}

Sibilia, Jean ^{[25
]}

Ravaud, Philippe ^{[26
]}

机构：

[1] Cochin Hosp, Rhumatol B, F-75014 Paris, France

[2] Univ Paris 05, INSERM Clin Epidemiol & Biostat U1153, PRES Sorbonne Paris Cite, F-75270 Paris 06, France

[3] CHU Clermont Ferrand, Dept Rheumatol, Clermont Ferrand, France

[4] Hop Hotel Dieu, AP HP, INSERM U738, Dept Epidemiol, Paris, France

[5] Univ Paris 06, Pitie Salpetriere Hosp, AP HP, Dept Rheumatol, Paris, France

[6] CHU Sud Hosp, Dept Rheumatol, Grenoble, France

[7] Purpan Hosp, Dept Rheumatol, Toulouse, France

[8] Bois Guillaume CHU, Dept Rheumatol, Rouen, France

[9] Univ Lille 2, CHU Roger Salengro Hosp, Dept Rheumatol, Lille, France

[10] Dept Rheumatol, Marseille, France

[11] Lapeyronie Hosp, Dept Rheumatol, Montpellier, France

[12] LArchet Hosp, Dept Rheumatol, Nice, France

[13] Pellegrin Hosp, Dept Rheumatol, Bordeaux, France

[14] Hop La Pitie Salpetriere, AP HP, Dept Rheumatol, Paris, France

[15] Univ Bretagne Occidentale, CHU Brest, Dept Rheumatol, F-29269 Brest, France

[16] Univ Bretagne Occidentale, CHU Brest, EA2216, F-29269 Brest, France

[17] Nancy Hosp, Dept Rheumatol, Nancy, France

[18] Univ Rennes 1, South Hosp, Fac Med, Dept Rheumatol, Rennes, France

[19] Le Mans Hosp, Dept Rheumatol, Le Mans, France

[20] Univ Paris Diderot, UFR Med, Paris, France

[21] Hop Lariboisiere, AP HP, Federat Rhumatol, F-75475 Paris, France

[22] Bicetre Hosp, AP HP, Dept Rheumatol, Le Kremlin Bicetre, France

[23] Univ Paris 06, Dept Rheumatol, Paris, France

[24] St Antoine Hosp, AP HP, DHU i2B, INSERM UMRS 938, Paris, France

[25] CHU Hautepierre, Federat Med Translat, UMR INSERM 1109, Dept Rheumatol, F-67098 Strasbourg, France

[26] Hop Xavier Bichat, AP HP, Dept Epidemiol, Paris, France

来源：

ANNALS OF THE RHEUMATIC DISEASES | 2015年 / 74卷 / 09期

关键词：

INCREASING PNEUMOCOCCAL VACCINATION; CARDIOVASCULAR-DISEASE; TENDER JOINTS; PRIMARY-CARE; EARLY RA; RISK; VALIDATION; HEALTH; RECOMMENDATIONS; OSTEOPOROSIS;

D O I：

10.1136/annrheumdis-2013-204733

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

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< 0.001); 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.

引用

页码：1725 / 1733

页数：9

共 66 条

[1]

[Anonymous], 2011, HYPERT CLIN MAN PRI

[2]

THE AMERICAN-RHEUMATISM-ASSOCIATION 1987 REVISED CRITERIA FOR THE CLASSIFICATION OF RHEUMATOID-ARTHRITIS [J].

ARNETT, FC ;

EDWORTHY, SM ;

BLOCH, DA ;

MCSHANE, DJ ;

FRIES, JF ;

COOPER, NS ;

HEALEY, LA ;

KAPLAN, SR ;

LIANG, MH ;

LUTHRA, HS ;

MEDSGER, TA ;

MITCHELL, DM ;

NEUSTADT, DH ;

PINALS, RS ;

SCHALLER, JG ;

SHARP, JT ;

WILDER, RL ;

HUNDER, GG .

ARTHRITIS AND RHEUMATISM, 1988, 31 (03) :315-324

[3]

Arnold M., 2011, Diabetes Care, V34, pe61, DOI DOI 10.2337/DC11-9998

[4]

Risk of Cardiovascular Mortality in Patients With Rheumatoid Arthritis: A Meta-Analysis of Observational Studies [J].

Avina-Zubieta, J. Antonio ;

Choi, Hyon K. ;

Sadatsafavi, Mohsen ;

Etminan, Mahyar ;

Esdaile, John M. ;

Lacaille, Diane .

ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH, 2008, 59 (12) :1690-1697

[5]

CONTROLLING THE FALSE DISCOVERY RATE - A PRACTICAL AND POWERFUL APPROACH TO MULTIPLE TESTING [J].

BENJAMINI, Y ;

HOCHBERG, Y .

JOURNAL OF THE ROYAL STATISTICAL SOCIETY SERIES B-STATISTICAL METHODOLOGY, 1995, 57 (01) :289-300

[6]

Cheung PP, 2013, CLIN EXP RHEUMATOL, V31, P490

[7]

The learning curve of nurses for the assessment of swollen and tender joints in rheumatoid arthritis [J].

Cheung, Peter P. ;

Dougados, Maxime ;

Andre, Vincent ;

Balandraud, Nathalie ;

Chales, Gerard ;

Chary-Valckenaere, Isabelle ;

Dernis, Emmanuelle ;

Gill, Ghislaine ;

Gilson, Melanie ;

Guis, Sandrine ;

Mouterde, Gael ;

Pavy, Stephan ;

Pouyol, Francois ;

Marhadour, Thierry ;

Richette, Pascal ;

Ruyssen-Witrand, Adeline ;

Soubrier, Martin ;

Minh Nguyen ;

Gossec, Laure .

JOINT BONE SPINE, 2014, 81 (02) :154-159

[8]

Reliability of Patient Self-Evaluation of Swollen and Tender Joints in Rheumatoid Arthritis: A Comparison Study With Ultrasonography, Physician, and Nurse Assessments [J].

Cheung, Peter P. ;

Ruyssen-Witrand, Adeline ;

Gossec, Laure ;

Paternotte, Simon ;

Le Bourlout, Catherine ;

Mazieres, Maryse ;

Dougados, Maxime .

ARTHRITIS CARE & RESEARCH, 2010, 62 (08) :1112-1119

[9]

Development and validation of a patient-based disease activity score in rheumatoid arthritis that can be used in clinical trials and routine practice [J].

Choy, Ernest H. ;

Khoshaba, Bernadette ;

Cooper, Derek ;

MacGregor, Alex ;

Scott, David L. .

ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH, 2008, 59 (02) :192-199

[10]

Randomized controlled trial of a primary care-based screening program to identify older women with prevalent osteoporotic vertebral fractures: Cohort for skeletal health in Bristol and Avon (COSHIBA) [J].

Clark, Emma M. ;

Gould, Virginia ;

Morrison, Leigh ;

Ades, A. E. ;

Dieppe, Paul ;

Tobias, Jon H. .

JOURNAL OF BONE AND MINERAL RESEARCH, 2012, 27 (03) :664-671

← 1 2 3 4 5 6 7 →