Comparative Effectiveness of a Nurse-Led Care Model vs Usual Care in Rheumatoid Arthritis: A Longitudinal Cohort...

BACKGROUND Achieving clinical remission in rheumatoid arthritis (RA) requires intensive monitoring and high patient adherence. While nurse-led care (NC) integrates specialized disease education and proactive monitoring, its association with long-term outcomes in real-world settings requires further investigation. This study aimed to examine the association between a specialized NC model and clinical remission rates over a 12-month period relative to usual care (UC) and standard pharmacotherapy (NO). MATERIAL AND METHODS This retrospective longitudinal cohort study analyzed 415 RA patients (NC: n=103; UC: n=132; NO: n=180) following treat-to-target protocols. Primary outcome was the association with clinical remission (disease activity score 28 with erythrocyte sedimentation rate [DAS28-ESR] <2.6) at 12 months. RESULTS At 12 months, the NC group exhibited a higher remission rate (41.7%) compared with the UC (28.0%) and NO (17.8%) groups (P<0.001). After adjusting for baseline disease activity and socioeconomic factors, the NC model was identified as a significant independent predictor of remission compared with NO (aOR 2.85) and UC (aOR 1.66). Longitudinal data showed a more pronounced decrease in mean DAS28-ESR within the NC group, correlated with improvements in objective joint counts and subjective assessments. High behavioral adherence was noted in the NC group, with laboratory compliance and medication persistence significantly exceeding that in the NO group (P<0.01). CONCLUSIONS Participation in a specialized NC model is strongly associated with an increased likelihood of clinical remission and superior patient adherence in RA. These findings suggest that integrated nursing support may serve as a beneficial framework correlated with the successful attainment of treat-to-target goals.