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OP0234 Impact of a Nurse Led Program on the Management of Comorbidities in Rheumatoid Arthritis (RA). Results of a Prospective, Multicentre, Randomized, Controlled Trial (Comedra)
  1. M. Soubrier1,
  2. E. Perrodeau2,
  3. P. Gaudin3,
  4. A. Cantagrel4,
  5. X. Le Loët5,
  6. R. Flipo6,
  7. S. Guis7,
  8. B. Combe8,
  9. L. Euller-Ziegler9,
  10. T. Schaeverbeke10,
  11. B. Fautrel11,
  12. A. Saraux12,
  13. I. Chary-Valckenaere13,
  14. G. Chales14,
  15. E. Dernis15,
  16. P. Richette11,
  17. X. Mariette16,
  18. F. Berenbaum11,
  19. J. Sibilia17,
  20. P. Ravaud2,
  21. M. Dougados18
  1. 1Dpt Rheum, Clermont-Fd
  2. 2Dpt Epidemiology, Paris
  3. 3Dpt Rheum, Grenoble
  4. 4Dpt Rheum, Toulouse
  5. 5Dpt Rheum, Rouen
  6. 6Dpt Rheum, Lille
  7. 7Dpt Rheum, Marseille
  8. 8Dpt Rheum, Montpellier
  9. 9Dpt Rheum, Nice
  10. 10Dpt Rheum, Bordeaux
  11. 11Dpt Rheum, Paris
  12. 12Dpt Rheum, Brest
  13. 13Dpt Rheum, Nancy
  14. 14Dpt Rheum, Rennes
  15. 15Dpt Rheum, Le Mans
  16. 16Dpt Rheum, Kremlin-Bicêtre
  17. 17Dpt Rheum, Strasbourg
  18. 18R. Descartes Univ., Paris, France

Abstract

Background Patients with RA are at an increased risk of developing a number of co-morbid conditions which have a major influence on both mortality and the outcome of RA.

Objectives To evaluate the impact of a nurse led program on the management of comorbidities (cardiovascular diseases (CVD), infection, cancer and osteoporosis) in RA.

Methods Study design: Prospective, randomized controlled open, 6-month trial (NCT #0131652). Patients: RA (ACR 1987 criteria). Study treatment: Collection of data by the nurse at a specific out-patient clinic for the four studied RA comorbidities according to the recommendations of the French Society of Rheumatology. In the event of non-agreement with the recommendation the patient was informed. A report summarizing the results of this program prepared by the nurse was sent to the patient’s attending physician and rheumatologist. Treatment allocation: After written informed consent, the study treatment was allocated randomly (i.e. either this evaluation of comorbidities or an evaluation of a self assessment program (not reported here). Outcome variables: number of actions undertaken against comorbidities according to the recommendations during the 6 months following this program. Actions taken into account for CVD were : introduction of lipid-lowering therapy or anti-platelet therapy, smoking cessation, taking of blood pressure, purchase of a sphygmomanometer, weight loss; for infections: pneumococcal, influenza, hepatitis and meningococcal vaccinations ; for cancers : mammography, Pap smears, consultation with an urologist, fecal occult blood testing, colonoscopy, consultation with a dermatologist; for osteoporosis: dual-Energy X-ray absorptiometry, increased alimentary calcium uptake, introduction of calcium and/or vitamin D supplementation and/or an osteoporotic medication.

Results There was no difference in the baseline characteristics of the 970 recruited patients (488 and 482 in the active and control groups, respectively): Age: 58±11 years, female gender: 79%, disease duration: 11[6.2-19.1] y, history or current biotherapy, DAS28: 3.1 ± 1.3., mHAQ: 0.25 (0.00-0.62). During the 6-month follow-up period, the number of actions per patient was statistically higher in the group comorbidities : 4.54 ± 2.08 vs 2.65 ± 1.57 (p< 0.001); Incidence Rate Ratio(IRR): 1.78 [1.60 -1.83]. This increase concerned CVD (IRR: 1.44 [1.30-1.61]), infections (IRR 1.78 [1.45 – 2.19]), cancer (IRR: 1.65 [1.42 – 1.92]) and osteoporosis (IRR 3.43 [2.88 – 4.13]).

Conclusions This study demonstrates the short-term benefit of a nurse led program on the management of comorbidities. Longer term follow-up of patients is required to better evaluate the sustainability of this benefit.

Acknowledgements This study was conducted thanks to a grant from the French National Research Program (PHRC) and thanks to an unrestricted grant from Roche Ltd France

Disclosure of Interest None Declared

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