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Ann Rheum Dis. 2014 May 28. pii: annrheumdis-2013-204733. doi: 10.1136/annrheumdis-2013-204733. [Epub ahead of print]

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).

Author information

  • 1Rhumatologie B, Cochin Hospital, Paris, France; rené Descartes University INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, France.
  • 2Department of Rheumatology, CHU Clermont-Ferrand, Clermont-Ferrand, France.
  • 3Department of Epidemiology, INSERM U738, APHP, Hôtel-Dieu Hospital, Paris, France.
  • 4Rheumatology Department, UPMC, Univ Paris 06, APHP, Pitié-Salpêtrière Hospital, Paris, France.
  • 5Department of Rheumatology, CHU Sud Hospital, Grenoble, France.
  • 6Department of Rheumatology, Purpan Hospital, Toulouse, France.
  • 7Department of Rheumatology, Bois-Guillaume CHU, Rouen, France.
  • 8Department of Rheumatology, CHU Roger Salengro Hospital, University of Lille 2, Lille, France.
  • 9Department of Rheumatology, Marseille, France.
  • 10Department of Rheumatology, Lapeyronie Hospital, Montpellier, France.
  • 11Department of Rheumatology, L'Archet Hospital, NICE, France.
  • 12Department of Rheumatology, Pellegrin Hospital, Bordeaux, France.
  • 13Department of Rheumatology, APHP, Pitié-Salpêtrière Hospital, Paris, France.
  • 14Department of Rheumatology, and EA2216, CHU Brest, Université de Bretagne Occidentale, France.
  • 15Department of Rheumatology, Nancy Hospital, Nancy, France.
  • 16Medecine Faculty, Department of Rheumatology, South Hospital, Rennes 1 University, Rennes, France.
  • 17Department of Rheumatology, Le Mans Hospital, Le Mans, France.
  • 18Université Paris Diderot, UFR médicale, Paris , France; APHP Hôpital Lariboisiére, Fédération de Rhumatologie, Paris, France.
  • 19Department of Rheumatology, APHP, Bicêtre Hospital, Le Kremlin-Bicetre, France.
  • 20Department of Rheumatology, Univ Paris 06 and INSERM UMRS_938, DHU i2B, APHP Saint- Antoine Hospital, Paris, France.
  • 21Department of Rheumatology, Hautepierre CHU, Fédération de médecine translationnelle, UMR INSERM 1109, Strasbourg, France.
  • 22Department of Epidemiology, APHP, Bichat Hospital, Paris, France.



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.


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.


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).


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.


NCT #01315652.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to


Cardiovascular Disease; Nursing; Rheumatoid Arthritis

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