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OP0284 Impact of a Nurse Led Program of Patient Self-Assessment of Disease Activity on the Management of Rheumatoid Arthritis: Results of a Prospective, Multicentre, Randomized, Controlled Trial (Comedra)
  1. M. Dougados1,
  2. E. Perrodeau2,
  3. F. Fayet3,
  4. P. Gaudin4,
  5. M.-H. Cerato5,
  6. X. le Loet6,
  7. R.-M. Flipo7,
  8. L. Chabrefy8,
  9. G. Mouterde9,
  10. L. Euller-Ziegler10,
  11. T. Schaeverbeke11,
  12. B. Fautrel12,
  13. A. Saraux13,
  14. I. Valckaenaere14,
  15. G. Chales15,
  16. E. Dernis16,
  17. P. Richette12,
  18. X. Mariette17,
  19. F. Berenbaum12,
  20. J. Sibilia18,
  21. P. Ravaud2
  1. 1René Descartes University
  2. 2Department of Epidemiology, Paris
  3. 3Department of Rheumatology, Clermont-Ferrand
  4. 4Department of Rheumatology, Grenoble
  5. 5Department of Rheumatology, Toulouse
  6. 6Department of Rheumatology, Rouen
  7. 7Department of Rheumatology, Lille
  8. 8Department of Rheumatology, Marseille
  9. 9Department of Rheumatology, Montpellier
  10. 10Department of Rheumatology, Nice
  11. 11Department of Rheumatology, Bordeaux
  12. 12Department of Rheumatology, Paris
  13. 13Department of Rheumatology, Brest
  14. 14Department of Rheumatology, Nancy
  15. 15Department of Rheumatology, Rennes
  16. 16Department of Rheumatology, Le Mans
  17. 17Department of Rheumatology, Le Kremlin-Bicêtre
  18. 18Department of Rheumatology, Strasbourg, France

Abstract

Background The current T2T and EULAR recommendations (e.g. measures of disease activity must be obtained and documented regularly [1]. Nurses should promote self-management skills in order that patients might achieve a greater self efficacy and improvement [2]) are difficult to apply in daily practice

Objectives To evaluate the impact of a nurse led program of patient self-assessment of disease activity on the management of Rheumatoid Arthritis (RA).

Methods Study design: Prospective, randomized, controlled, open, 6-month trial (NCT #0131652).Participants 1/Patients: Consecutive RA attending a clinic of the 20 participating centers were invited .2/ Nurses :all participated at a 1.5 day training session prior the start of the study. 3/Treating rheumatologists: aware of the study but not of its primary objective.

Study treatment: a program including: 1) a video explaining both the interest, calculation and interpretation of the DAS28-ESR, 2) Training of a self joint assessment, 3) A booklet and a calculator permitting the patient to report the results of his/her “auto” DAS28-ESR and to show the results to his/her treating rheumatologist.

Treatment allocation:After written informed consent, the treatment was allocated randomly via en electronic system (e.g. either this above program or an evaluation of potential co-morbidities (not reported here). Outcome variables:Primary: percentage of patients with a change in DMARD therapy during the 6 months follow-up period. Other variables: changes in symptomatic parameters.

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] years, DAS28-ESR: 3.1±1.3, mHAQ: 0.25[0.00-0.62]; RAID: 2.7[1.3-4.3]. At the month 6 visit, the % patients bringing back a completed booklet was 89%. During the 6 months follow-up period, a DMARD therapy was changed in 17.2% vs. 10.9% in the active vs. control group (p=0.0012) (OR=1.70 [1.17-2.19]). During the time of the study, there was no statistically significant inter-group differences (-0.10 [-0.10;0.3], p=0.41; -0.03 [-0.25; 0.18], p=0.761; -0.01 [-0.05; 0.04], p=0.806, in the DAS28-ESR, HAQ and RAID in the active vs. control group respectively.

Conclusions This study demonstrates the short term impact of a nurse leaded patient self assessment of RA disease activity program. Longer term follow up of patients is required to better evaluate the clinical benefit of this program

References

  1. Smolen J.S. et al; Ann Rheum Dis 2010; 69, 631-7

  2. Van Eijk-Hustings y. et al. Ann Rheum Dis. 2012; 71, 13-9

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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