Article open access publication

Efficacy of embedded nurse-led versus conventional physician-led follow-up in rheumatoid arthritis: a systematic review and meta-analysis

RMD Open, BMJ, ISSN 2056-5933

Volume 3, 2, 2017

DOI:10.1136/rmdopen-2017-000481, Dimensions: pub.1091224211, PMC: PMC5574437, PMID: 28879053,



  1. (1) Aarhus University, grid.7048.b, AU
  2. (2) Aarhus University Hospital, grid.154185.c, Central Denmark Region
  3. (3) University of Copenhagen, grid.5254.6, KU
  4. (4) Rigshospitalet, grid.475435.4, Capital Region
  5. (5) University of Southern Denmark, grid.10825.3e, SDU
  6. (6) Hospital of Southern Jutland, grid.416811.b, Southern Denmark Region
  7. (7) King Christian X's Hospital for Rheumatic Diseases, Graasten, Denmark






OBJECTIVE: To compare the efficacy of embedded nurse-led versus conventional physician-led follow-up on disease activity in patients with rheumatoid arthritis (RA). METHODS: In a systematic literature search, we identified randomised controlled trials (RCTs) reporting on the efficacy of nurse-led follow-up on disease control in patients with RA compared with physician-led follow-up. Primary outcome was disease activity indicated by Disease Activity Score (DAS)-28. Secondary outcomes were: patient satisfaction, physical disability, fatigue, self-efficacy and quality of life. Outcomes were assessed after 1-year and 2 year follow-ups. RESULTS: Seven studies representing five RCTs, including a total of 723 participants, were included. All but one study included stable patients in low disease activity or remission at baseline. No difference in DAS-28 was found after 1 year (mean difference (MD) -0.07 (95% CI -0.23 to 0.09)). After 2 years, a statistically significant difference was seen in favour of nurse-led follow-up (MD -0.28 (95% CI -0.53 to -0.04)). However, the difference did not reach a clinically relevant level. No difference was found in patient satisfaction after 1 year (standard mean difference (SMD) -0.17 (95 % CI -1.0 to 0.67), whereas a statistical significant difference in favour of nurse-led follow-up was seen after 2 years (SMD: 0.6 (95% CI -0.00 to 1.20)). CONCLUSION: After 1 year no difference in disease activity, indicated by DAS-28, were found between embedded nurse-led follow-up compared with conventional physician-led follow-up, in RA patients with low disease activity or remission.

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