Disease activity improvement in rheumatoid arthritis : nurse-led versus physician-led care

Abstract

Overview: Rheumatoid Arthritis (RA) is a chronic autoimmune inflammatory disease prevalent among older adults, causing physical and functional disabilities. Therefore, it often requires long-term disease management. Due to an increased global demand of RA care, nurse-led care (NLC) may serve as an alternative to physician-led care. Research Question: Does nurse-led care facilitate better improvement of the disease activity when compared to the physician-led care among rheumatoid arthritis patients? PICO elements: Population (P) studied were RA patients with intervention (I) as nurse-led care, comparison (C) as physician-led care. The desired outcome (O) was better improvement of the disease activity. Method: The key elements of the PICO question used to generate various form of terms, combined with different search tools. A systematic search was conducted using the EBSCOhost platform while Scopus, Nursing & Allied Health Database (ProQuest) and PubMed. The PRISMA 2009 checklist was used to map the selection process. Studies used included RA adults aged over 16 years, peer-reviewed RA studies, published in the English language during the year 2010-2020. Five studies were selected, which include three randomised controlled trials, one quasi-experimental trial and one observational prospective cohort study. They were appraised using The CASP tool. Results: Nurse-led care was found to be as effective in managing the disease activity in RA patients as physician-led care. However, no significant differences were found between the two groups. Conclusion: The research question remains inconclusive and warrants further long-term trials comparing the two groups. Recommendations and implications: Further research is required on NLC and its cost-effectiveness in Malta.