Screening for and management of comorbidities after a nurse-led program: results of a 3-year longitudinal study in 769 established rheumatoid arthritis patients

Laure Gossec, Martin Soubrier, Frantz Foissac, Anna Molto, Pascal Richette, Catherine Beauvais, Adeline Ruyssen-Witrand, Aleth Perdriger, Isabelle Chary-Valckenaere, Gael Mouterde, Emanuelle Dernis, Liana Euller-Ziegler, René-Marc Flipo, Mélanie Gilson, Sandrine Guis, Xavier Mariette, Sophie Pouplin, Thierry Marhadour, Thierry Schaeverbeke, Christelle Sordet, Françoise Fayet, Maxime Dougados, Laure Gossec, Martin Soubrier, Frantz Foissac, Anna Molto, Pascal Richette, Catherine Beauvais, Adeline Ruyssen-Witrand, Aleth Perdriger, Isabelle Chary-Valckenaere, Gael Mouterde, Emanuelle Dernis, Liana Euller-Ziegler, René-Marc Flipo, Mélanie Gilson, Sandrine Guis, Xavier Mariette, Sophie Pouplin, Thierry Marhadour, Thierry Schaeverbeke, Christelle Sordet, Françoise Fayet, Maxime Dougados

Abstract

Background/purpose: Cardiovascular (CV) risk, cancer, infections and osteoporosis should be screened for in rheumatoid arthritis (RA). The objective was to assess 3-year effects of a nurse visit for comorbidity counselling.

Methods: This was an open long-term (3 years) extension of the Comorbidities and Education in Rheumatoid Arthritis 6-month randomised controlled trial in which patients with definite, stable RA were visiting a nurse for comorbidity counselling. Comorbidity status was assessed and nurses provided advice on screening and management, at baseline and 3 years later. A score was developed to quantify comorbidity screening and management: 0-100, where lower scores indicate better screening and management. The score was compared between baseline and 3-year assessment using a Wilcoxon test for paired data.

Results: Of the 970 recruited patients, 776 (80%) were followed-up at 2-4 years and 769 (79%) had available data for comorbidities at both time points: mean (±SD) age 58 (±11) years and mean disease duration 14 (±10) years; 614 (80%) were women, the mean Disease Activity Score 28 was 3.0±1.3, and 538 (70%) were receiving a biologic. At baseline, the mean comorbidity screening score was 36.6 (±19.9) and it improved at 3 years to 24.3 (±17.8) (p<0.0001), thus with a relative improvement of 33% (improvement of 12 points). CV risk screening, vaccination status and bone densitometry performance improved the most.

Conclusions: Comorbidity screening was suboptimal but improved notably over 3 years, after a nurse-led programme aiming at checking systematically for comorbidity screening and giving patient advice. This long-term efficacy pleads in favour of nurse-led interventions to better address comorbidities in RA.

Trial registration number: NCT01315652.

Keywords: cardiovascular disease; multidisciplinary team care; nursing; rheumatoid arthritis; vaccination.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flowchart of patient disposition in the COMEDRA trial and for the 3-year follow-up. COMEDRA, Comorbidities and Education in Rheumatoid Arthritis; M0, month 0; M6, month 6; RA, rheumatoid arthritis.
Figure 2
Figure 2
Comorbidity screening and prevention score. (A) Baseline score. (B) Three years follow-up score.

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