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Ann Rheum Dis. 2019 Jul 12. pii: annrheumdis-2019-215458. doi: 10.1136/annrheumdis-2019-215458. [Epub ahead of print]

2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis.

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Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet - Glostrup, Glostrup, Denmark
Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.
Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands.
CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal.
Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.
Bulgarian Organisation for People with Rheumatic Diseases (BOPRD),, Sofia, Bulgaria.
Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy.
Department of Medicine, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, Italy.
Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France.
Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Health Sciences Research Unit: Nursing (UICiSA:E), Nursing School of Coimbra, Coimbra, Portugal.
Clinic for Immunology and Rheumatology, Hannover Medical School, Hannover, Germany.
Institute of Nursing Science (INS), Department of Public Health (DPH), University of Basel, Basel, Switzerland.
Department of Rheumatology, Immunology and Allergology, Inselspital University Hospital Bern, Bern, Switzerland.
Lahti University of Applied Sciences, Faculty of Social and Health Care, Lahti, Finland.
Department of Internal Medicine, Clinic II, Medical University of Innsbruck, Innsbruck, Austria.
Rheumatic Musculoskeletal Disease Unit, Our Lady's Hospice and Care Services, Dublin, Ireland.
Clinica Reumatologica, Ospedale C. Urbani, Università Politecnica delle Marche, Jesi (An), Italy.
Department of Nursing and Midwifery, University of the West of England, Bristol, UK.
Department of Rhematology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Department of Rehabilitation, Institute of Rheumatology, Prague, Czech Republic.
Day Hospital Unit, Alicante General and University Hospital, Alicante, Spain.
School of Healthcare, University of Leeds, Leeds, UK.
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands.


To update the European League Against Rheumatism (EULAR) recommendations for the role of the nurse in the management of chronic inflammatory arthritis (CIA) using the most up to date evidence. The EULAR standardised operating procedures were followed. A task force of rheumatologists, health professionals and patients, representing 17 European countries updated the recommendations, based on a systematic literature review and expert consensus. Higher level of evidence and new insights into nursing care for patients with CIA were added to the recommendation. Level of agreement was obtained by email voting. The search identified 2609 records, of which 51 (41 papers, 10 abstracts), mostly on rheumatoid arthritis, were included. Based on consensus, the task force formulated three overarching principles and eight recommendations. One recommendation remained unchanged, six were reworded, two were merged and one was reformulated as an overarching principle. Two additional overarching principles were formulated. The overarching principles emphasise the nurse's role as part of a healthcare team, describe the importance of providing evidence-based care and endorse shared decision-making in the nursing consultation with the patient. The recommendations cover the contribution of rheumatology nursing in needs-based patient education, satisfaction with care, timely access to care, disease management, efficiency of care, psychosocial support and the promotion of self-management. The level of agreement among task force members was high (mean 9.7, range 9.6-10.0). The updated recommendations encompass three overarching principles and eight evidence-based and expert opinion-based recommendations for the role of the nurse in the management of CIA.


arthritis; health services research; nursing; patient perspective; rheumatoid arthritis

Conflict of interest statement

Competing interests: None declared.

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