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.