Background Studies have indicated that follow-up by nursing consultations or different versions of shared care are not inferior to medical follow-up in controlling disease activity in patients with rheumatoid arthritis (RA) (1,2).
Objectives To explore whether RA patients disease status, function and progression of erosions would differ depending on the type of follow-up care: 1) planned nursing consultations every three months, 2) shared care with no planned consultations but access to the General Practitioner and a nurse-led telephone help-line or 3) traditional rheumatologist initiated follow-up.
Methods In a randomised controlled trial 287 adult outpatients in stable non-biological treatment, DAS-28<3.2, HAQ<2.5 and at least 18 months of disease duration were allocated to one of the three types of follow-up care for the following two years. DAS-28, HAQ, VAS-fatigue and pain were assessed at enrollment, one and two years follow-up. Clinical evaluation was performed yearly by a blinded investigator. Mixed effect models were used to examine the data. Progression of erosions in hands and feet from x-rays at baseline and two-years follow-up were explored in logistic regression analysis controlling for erosions and positive anti-CCP at baseline.
Results Across all participants a significant increase was seen in DAS-28 (0.51, p<0.001), HAQ (0.086, p=0.012) and pain (4.26, p=0.019) from baseline till two-years follow-up. VAS-fatigue remained stable during the two years. No significant differences were seen between the groups in these outcome measures or in the number of participants with DAS-28>3.2 at two-year follow up (28 (29%), 19 (20%) and 17 (18%) of the participants in the medical, shared care and nursing group respectively). The odds ratio for progression on x-rays in the shared care and the nursing group did not differ from the medical group (shared care OR 0.56, p=0.264 (CI: 0.28-1.55), nursing group OR 1.03, p=0.945 (CI: 0.44-2.56)). There was no significant difference between the groups in the number of adverse events.
Conclusions In patients with established RA and low disease activity it is considered to be safe to implement shared care and nursing consultations without differences in disease control compared to traditional medical follow-up.
 Hewlett S, Kirwan J, Pollock J, Mitchell K, Hehir M, Blair PS et al. Patient initiated outpatient follow up in rheumatoid arthritis: six year randomised controlled trial. BMJ 2005; 330(7484):171.
 Hill J, Thorpe R, Bird H. Outcomes for patients with RA: A rheumatology nurse practitioner clinic compared to standard outpatient care. Musculoskeletal Care 2003; 1(1):5-20.
Disclosure of Interest None Declared
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