PT  - JOURNAL ARTICLE
AU  - Dougados, Maxime
AU  - Soubrier, Martin
AU  - Perrodeau, Elodie
AU  - Gossec, Laure
AU  - Fayet, Françoise
AU  - Gilson, Mélanie
AU  - Cerato, Marie-Hélène
AU  - Pouplin, Sophie
AU  - Flipo, René-Marc
AU  - Chabrefy, Laurent
AU  - Mouterde, Gael
AU  - Euller-Ziegler, Liana
AU  - Schaeverbeke, Thierry
AU  - Fautrel, Bruno
AU  - Saraux, Alain
AU  - Chary-Valckenaere, Isabelle
AU  - Chales, Gérard
AU  - Dernis, Emmanuelle
AU  - Richette, Pascal
AU  - Mariette, Xavier
AU  - Berenbaum, Francis
AU  - Sibilia, Jean
AU  - Ravaud, Philippe
TI  - Impact of a nurse-led programme on comorbidity management and impact of a patient self-assessment of disease activity on the management of rheumatoid arthritis: results of a prospective, multicentre, randomised, controlled trial (COMEDRA)
AID  - 10.1136/annrheumdis-2013-204733
DP  - 2015 Sep 01
TA  - Annals of the Rheumatic Diseases
PG  - 1725--1733
VI  - 74
IP  - 9
4099  - http://ard.bmj.com/content/74/9/1725.short
4100  - http://ard.bmj.com/content/74/9/1725.full
SO  - Ann Rheum Dis2015 Sep 01; 74
AB  - Objectives Rheumatoid arthritis (RA) patients are at an increased risk of developing comorbid conditions. A close monitoring of the disease targeting a status of low disease activity is associated with a better outcome. The aim of this trial was to evaluate the impact of a nurse-led programme on comorbidities and the impact of patient self-assessment of disease activity on the management of RA.Methods We enrolled 970 patients (mean age 58 years, 79% women) in a prospective, randomised, controlled, open-label, 6-month trial. In the comorbidity group (n=482), the nurse checked comorbidities and sent the programme results to the attending physicians. In the self-assessment group (n=488), the nurse taught the patient how to calculate his/her Disease Activity Score which had to be reported on a booklet to be shared with the treating rheumatologist. The number of measures taken for comorbidities and the percentage of patients recording a change (initiation, switch or increased dose) in disease-modifying antirheumatic drugs (DMARDs) in the 6 months follow-up period of the study defined the outcomes of the trial.Results The number of measures taken per patient was statistically higher in the comorbidity group: 4.54±2.08 versus 2.65±1.57 (p<0.001); incidence rate ratio: 1.78 (1.61–1.96) and DMARD therapy was changed more frequently in the self-assessment group: 17.2% versus 10.9% (OR=1.70 (1.17; 2.49), p=0.006).Conclusions This study demonstrates the short-term benefit of a nurse-led programme on RA comorbidity management and the impact of patient self-assessment of disease activity on RA treatment intensification.Trial registration number NCT #01315652.