Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, 200 1st St. SW, Rochester, MN, 55905, USA.
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Clin Rheumatol. 2019 Nov;38(11):3025-3032. doi: 10.1007/s10067-019-04664-5. Epub 2019 Jul 1.
INTRODUCTION/OBJECTIVES: To evaluate the effect of a flare management intervention guided by non-physician providers versus usual care between rheumatology visits on flare occurrence and rheumatoid arthritis (RA) disease activity.
Adult patients with established RA (per 2010 ACR criteria, n = 150) were randomized to the intervention arm (n = 75) versus usual care (n = 75). The Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire was administered monthly during 24 months to all patients in the intervention arm to assess flare status. Telephone nurse-led counseling or an expedited visit with a rheumatology provider was offered to patients in the intervention arm who indicated they were in flare.
Patients in the intervention arm completed a median of 8.5 (range 1-24) questionnaires. RA flare was reported on 122 (19%) of these questionnaires; average FLARE-RA score, 4.72 on 0 (no flare) to 10 (maximum flare) scale. Patients preferred an expedited clinic visit with a rheumatology provider during 39 (32%) of flares. The majority of patients preferred to self-manage their flare (76, 62%); some patients received nursing advice on flare management over the phone (7, 6%). There were no differences in RA flare by OMERACT9 definition, DAS28-CRP, CDAI, SDAI, anti-rheumatic treatment change by rheumatology provider, or remission by CDAI between the study arms over 24-month follow-up.
The flare management intervention did not have any major effect on flare occurrence or RA disease activity metrics over the 24-month follow-up. The majority of patients in the intervention arm preferred self-management to an expedited visit with their rheumatology provider.
ClinicalTrials.gov Identifier: NCT02382783 ( https://clinicaltrials.gov/ct2/show/NCT02382783 ) Key Points • The flare management intervention had no effect on rheumatoid arthritis (RA) disease activity. • Patients preferred self-management of their RA flares to expedited rheumatology provider visits.
简介/目的：评估在风湿科就诊期间由非医师提供者指导的发作管理干预与常规护理相比，对发作发生和类风湿关节炎（RA）疾病活动度的影响。
符合 2010 年 ACR 标准的成年 RA 患者（n=150）随机分配至干预组（n=75）或常规护理组（n=75）。在 24 个月期间，所有干预组患者每月都要使用 Flare Assessment in Rheumatoid Arthritis（FLARE-RA）问卷评估发作情况。如果患者表示处于发作状态，干预组患者将由电话护士进行指导或与风湿病专家进行紧急就诊。
干预组患者完成了中位数为 8.5（范围 1-24）次的问卷。在这些问卷中，有 122 次（19%）报告了 RA 发作；平均 FLARE-RA 评分为 0（无发作）至 10（最大发作）刻度上的 4.72。在 39 次发作（32%）中，患者更倾向于接受风湿病专家的紧急就诊。大多数患者更愿意自行管理发作（76 例，62%）；一些患者通过电话获得了关于发作管理的护理建议（7 例，6%）。在 24 个月的随访期间，根据 OMERACT9 定义、DAS28-CRP、CDAI、SDAI、风湿病专家对治疗的调整或 CDAI 缓解，两组间 RA 发作的差异无统计学意义。
在 24 个月的随访期间，发作管理干预措施对发作发生或 RA 疾病活动指标均无明显影响。干预组中的大多数患者更倾向于自行管理发作，而不是接受风湿病专家的紧急就诊。
ClinicalTrials.gov 标识符：NCT02382783（https://clinicaltrials.gov/ct2/show/NCT02382783）
发作管理干预措施对类风湿关节炎（RA）疾病活动度没有影响。
患者更愿意自行管理 RA 发作，而不是接受风湿病专家的紧急就诊。
