Outcomes for patients with RA: a rheumatology nurse practitioner clinic compared to standard outpatient care

The study aimed to extend our previous work by comparing the outcome of patients with rheumatoid arthritis (RA) attending a rheumatology nurse practitioner (RNP) clinic with those of patients attending the more traditional junior hospital doctor's clinic (JHD).

A randomised controlled trial of 80 people with RA were allocated to either an RNP or JHD clinic and seen six times in 12 months. The primary outcome measure was the DAS28. Secondary measures included stiffness, fatigue, physical function, psychological status, knowledge and satisfaction.

Number of patients: RNP 39 (8 males); JHD 41 (9 males). Age of patients: RNP 36-76 years (median 57); JHD 35-74 years (median 57). Median disease duration: RNP 12 years (range 2-40); JHD 17 years (range 1.5-41). Years of full time education: RNP 8-17 years (median 10); JHD 9-20 years (median 10). Week 48 DAS scores compared to baseline: RNP 19 unchanged, 6 worse and 11 better; JHD 22 unchanged, 7 worse, 6 better. Length of morning stiffness increased significantly at week 24 (p = 0.05) in the JHD cohort but improved to become non-significant at week 48 (p = 0.09). By week 48 fatigue had improved in the RNP cohort (p = 0.038) and deteriorated in JHD patients (p = 0.008). The AIMS showed decreases in pain in the RNP cohort (p = 0.044) and worsening physical function in JHD patients (p = 0.038). Patient satisfaction in the RNP cohort increased significantly (overall satisfaction p = 0.000). The JHD cohort showed a decrease in satisfaction with access and continuity (p = 0.027).

The findings from this research confirm that care from the RNP is both effective and safe. Furthermore, a specialist RNP can bring additional benefits in the form of greater symptom control and enhanced patient self-care.