In an effort to address a predicted shortage of rheumatologists, researchers wanted to see whether rheumatology nurses and general practitioners could provide effective continuing care.

A total of 287 adult outpatients with rheumatoid arthritis were enrolled between 2008 and 2010. All patients attended two educational sessions focused on enhancing their self-efficacy and ability to recognize when they need to obtain help. Participants were then randomized into the control group (usual care, consisting of follow-up with a rheumatologist every three to 12 months), a shared-care group (participants contacted their general practitioner, who could consult a rheumatologist or a rheumatology outpatient nurse through a telephone helpline as needed), or a nursing group (30-minute consultations every three months with a rheumatology outpatient nurse able to make referrals; patients had access to the telephone helpline as well).

The primary outcome measure was disease activity, which was similar across the three groups at baseline and at the one- and two-year follow-up points. The number of patients with disease progression identified on X-rays was comparable across the groups during the study period as well.

Patients in the nursing group scored higher on measures of self-efficacy, satisfaction, and confidence than those in the control group. Although compliance with blood testing schedules was lower among patients in the shared group than in the rheumatologist and nursing groups, out-of-range test results occurred at similar rates in all three groups.

The authors concluded that patients with rheumatoid arthritis can safely receive follow-up care from experienced rheumatology nurses or from general practitioners with access to rheumatologists and rheumatology nurses.

The authors say that there is a need for additional studies examining the effects of care provided by rheumatology nurses on a less-frequent follow-up schedule and such care provided to patients with more active disease.

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