Article Text

2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis
  1. Bianca Bech1,
  2. Jette Primdahl2,3,
  3. Astrid van Tubergen4,5,
  4. Marieke Voshaar6,
  5. Heidi A Zangi7,
  6. Lurdes Barbosa8,
  7. Carina Boström9,10,
  8. Boryana Boteva11,
  9. Francesco Carubbi12,13,
  10. Françoise Fayet14,
  11. Ricardo J O Ferreira15,16,
  12. Kirsten Hoeper17,
  13. Agnes Kocher18,19,
  14. Marja Leena Kukkurainen20,
  15. Vivienne Lion21,
  16. Patricia Minnock22,
  17. Antonella Moretti23,
  18. Mwidimi Ndosi24,
  19. Milena Pavic Nikolic25,
  20. Michael Schirmer21,
  21. Hana Smucrova26,
  22. Jenny de la Torre-Aboki27,
  23. Jennifer Waite-Jones28,
  24. Yvonne van Eijk-Hustings29
  1. 1 Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet - Glostrup, Glostrup, Denmark
  2. 2 Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
  3. 3 Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
  4. 4 Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
  5. 5 CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
  6. 6 Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
  7. 7 National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  8. 8 Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal
  9. 9 Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
  10. 10 Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
  11. 11 Bulgarian Organisation for People with Rheumatic Diseases (BOPRD),, Sofia, Bulgaria
  12. 12 Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
  13. 13 Department of Medicine, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, Italy
  14. 14 Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
  15. 15 Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  16. 16 Health Sciences Research Unit: Nursing (UICiSA:E), Nursing School of Coimbra, Coimbra, Portugal
  17. 17 Clinic for Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
  18. 18 Institute of Nursing Science (INS), Department of Public Health (DPH), University of Basel, Basel, Switzerland
  19. 19 Department of Rheumatology, Immunology and Allergology, Inselspital University Hospital Bern, Bern, Switzerland
  20. 20 Lahti University of Applied Sciences, Faculty of Social and Health Care, Lahti, Finland
  21. 21 Department of Internal Medicine, Clinic II, Medical University of Innsbruck, Innsbruck, Austria
  22. 22 Rheumatic Musculoskeletal Disease Unit, Our Lady's Hospice and Care Services, Dublin, Ireland
  23. 23 Clinica Reumatologica, Ospedale C. Urbani, Università Politecnica delle Marche, Jesi (An), Italy
  24. 24 Department of Nursing and Midwifery, University of the West of England, Bristol, UK
  25. 25 Department of Rhematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
  26. 26 Department of Rehabilitation, Institute of Rheumatology, Prague, Czech Republic
  27. 27 Day Hospital Unit, Alicante General and University Hospital, Alicante, Spain
  28. 28 School of Healthcare, University of Leeds, Leeds, UK
  29. 29 Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
  1. Correspondence to Bianca Bech, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet - Glostrup, Glostrup 2600, Denmark; biancabech{at}


To update the European League Against Rheumatism (EULAR) recommendations for the role of the nurse in the management of chronic inflammatory arthritis (CIA) using the most up to date evidence. The EULAR standardised operating procedures were followed. A task force of rheumatologists, health professionals and patients, representing 17 European countries updated the recommendations, based on a systematic literature review and expert consensus. Higher level of evidence and new insights into nursing care for patients with CIA were added to the recommendation. Level of agreement was obtained by email voting. The search identified 2609 records, of which 51 (41 papers, 10 abstracts), mostly on rheumatoid arthritis, were included. Based on consensus, the task force formulated three overarching principles and eight recommendations. One recommendation remained unchanged, six were reworded, two were merged and one was reformulated as an overarching principle. Two additional overarching principles were formulated. The overarching principles emphasise the nurse’s role as part of a healthcare team, describe the importance of providing evidence-based care and endorse shared decision-making in the nursing consultation with the patient. The recommendations cover the contribution of rheumatology nursing in needs-based patient education, satisfaction with care, timely access to care, disease management, efficiency of care, psychosocial support and the promotion of self-management. The level of agreement among task force members was high (mean 9.7, range 9.6-10.0). The updated recommendations encompass three overarching principles and eight evidence-based and expert opinion-based recommendations for the role of the nurse in the management of CIA.

  • arthritis
  • health services research
  • nursing
  • patient perspective
  • rheumatoid arthritis

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  • Handling editor Josef S Smolen

  • Contributors YvE-H and AvT applied and received the EULAR project grant and assembled the task force. YvE-H and BB performed the systematic literature research. JP, AvT, HAZ, MV and YvE-H participated in the steering committee. BB was responsible for drafting the first version of the manuscript. All authors have critically reviewed the draft for important intellectual content and approved the final version of the manuscript.

  • Funding This work is endorsed and financed by EULAR. Grant number HPR036.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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