Specialist nurses as good as doctors in managing rheumatoid arthritis patients

August 28, 2013

Patients attending clinical nurse specialist clinics do not get inferior treatment to that offered by consultant rheumatologists, the results of a major new clinical trial have revealed.

The results of the multi-centre trial at the University of Leeds, funded by Arthritis Research UK, showed that there may be some to people with rheumatoid arthritis, whose condition is managed in clinics run by rheumatology clinical nurse specialists, especially with respect to their disease activity, pain control, physical function and general satisfaction with their care.

Rheumatoid arthritis is a , which if untreated may lead to severe disability or death. However, the management of the disease has changed significantly over the past ten years due to better understanding of the disease process, an emphasis on early diagnosis, intensive treatment and the use of more efficacious .

The nation-wide trial was led by Dr Mwidimi Ndosi, of the University's Institute of Rheumatic and Musculoskeletal Medicine, and former University academic Dr Jackie Hill. It compared the outcomes of 180 people with rheumatoid arthritis in 10 out-patient clinics around the UK, half run by clinical nurse specialists, and the other by rheumatologists.

In both groups the nurse or doctor took a patient history, carried out a physical examination, discussed pain control, change of drugs or dose (including ) and offered patient education and psychosocial support. The nurse-led clinics' appointment times were on average longer than the consultants' (20 vs 15 minutes).

The results of the study, published in the Annals of the Rheumatic Diseases, found that although the nurses made fewer changes to a patient's medication and ordered fewer x-rays and steroid injections, their patients saw greater improvement in disease activity than those under rheumatologists' care. Nurses also provided patient education and psychosocial support more frequently than rheumatologists, and their patients also had fewer unplanned hospital admissions or visits to accident and emergency units.

"The results of this study show that clinics run by rheumatology clinical nurse specialists can manage many people with rheumatoid arthritis without any reduction in the quality of care and treatment," said Dr Ndosi.

In addition to better improvements in the disease activity, nurse-led clinics had overall lower healthcare costs, representing a cost-effective service. The economic evaluation took into account healthcare resource use, including consultation costs, investigations, hospital admissions and treatments including over-the-counter medications.

Interestingly, throughout the 12-month follow-up period, the proportion of patients receiving expensive biologic drug treatment remained more or less constant in the nurse-led clinics, while that of rheumatologist-led clinics doubled.

"The development of the role of clinical nurse specialist in rheumatology has resulted in great improvements in rheumatology service, providing a high quality, accessible and person-centred care to people with ," said Dr Hill.

"The results of this research are encouraging, demonstrating that this model of care is effective, safe, and associated with more patient satisfaction. At a time when deficiencies have come to light in some areas of the NHS, it's good to know that in rheumatology there are high levels of satisfaction with the care we provide."

Professor Alan Silman, medical director of Arthritis Research UK commented: "Rheumatoid arthritis is, despite modern treatment, a chronic condition requiring long-term expert professional care to help patients manage their symptoms and control disease. This care necessarily involves many different healthcare professionals.

"Why this study is so important is that it shows that specialist trained nurses can improve outcome, enhance the patient experience and reduce costs when compared to conventional doctor-led services.

"There will obviously always be a place for specialist medical input at certain times in the patient journey, but this study shows the importance of specialist rheumatology team work, and is a future model of care which requires serious consideration for widespread implementation within the NHS."

Explore further: Nurse-led programs help patients self-manage RA

Related Stories

Nurse-led programs help patients self-manage RA

June 14, 2013
Data first presented today at EULAR 2013, the Annual Congress of the European League Against Rheumatism demonstrate the benefits of a nurse-led programme on patient self-management and the management of rheumatoid arthritis ...

More cancer specialist nurses to improve hospital care

June 6, 2013
Patients battling cancer have a better experience of care at hospitals that employ more cancer specialist nurses.

Expensive or not, rheumatoid arthritis drugs have similar effect: study

July 1, 2013
(HealthDay)—Treatment with a pricey biological drug was no better than cheaper, conventional therapy in terms of reducing time off from work for people with rheumatoid arthritis, a new study finds.

Delays in specialist assessment of rheumatoid arthritis are too long

August 8, 2011
Delays in the specialist assessment of patients with suspected rheumatoid arthritis (RA) are “unacceptably long,” finds a study carried out in eight European countries led by the University of Birmingham, published ...

ACR endorses standardized measures to determine rheumatoid arthritis disease activity

April 2, 2012
A working group convened by the American College of Rheumatology (ACR) has evaluated more than 60 disease activity measures for rheumatoid arthritis (RA). The group narrowed the number of RA disease activity measures and ...

Recommended for you

Fluid in the knee holds clues for why osteoarthritis is more common in females

June 26, 2017
Researchers have more evidence that males and females are different, this time in the fluid that helps protect the cartilage in their knee joints.

Biologics before triple therapy not cost effective for rheumatoid arthritis

May 29, 2017
Stepping up to biologic therapy when methotrexate monotherapy fails offers minimal incremental benefit over using a combination of drugs known as triple therapy, yet incurs large costs for treating rheumatoid arthritis (RA). ...

Drug for refractory psoriatic arthritis shows promise in clinical trial

May 24, 2017
In a pivotal phase-3 clinical trial led by a Stanford University School of Medicine investigator, patients with psoriatic arthritis for whom standard-of-care pharmaceutical treatments have provided no lasting relief experienced ...

Cross-species links identified for osteoarthritis

May 17, 2017
New research from the University of Liverpool, published today in the journal npj Systems Biology and Applications, has identified 'cell messages' that could help identify the early stages of osteoarthritis (OA).

Osteoarthritis could be prevented with good diet and exercise

May 12, 2017
Osteoarthritis can potentially be prevented with a good diet and regular exercise, a new expert review published in the Nature Reviews Rheumatology reports.

Rodents with trouble walking reveal potential treatment approach for most common joint disease

May 11, 2017
Maintaining the supply of a molecule that helps to nourish cartilage prevented osteoarthritis in animal models of the disease, according to a report published in Nature Communications online May 11.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.