Do patients prefer nurse specialists to manage their DMARD treatment?


People taking disease-modifying antirheumatic drugs (DMARDs) for inflammatory arthritis are more likely to be satisfied with their care if they have follow-up appointments with a clinical nurse specialist, rather than with a doctor, a study shows.


‘Inflammatory arthritis’ is an umbrella term that covers several conditions, including rheumatoid arthritis, ankylosing
spondylitis, psoriatic arthritis, and juvenile idiopathic arthritis. These are all autoimmune diseases that affect the joints. This means that the body’s immune system mistakenly attacks the joints, making them inflamed and painful.

These conditions are often treated with medicines called disease-modifying antirheumatic drugs (DMARDs). These drugs can reduce the joint damage caused by these illnesses, and improve symptoms. People taking DMARDs have regular appointments to check on how well the treatment is working, whether it needs to be adjusted, and whether it is causing any side effects.

In some countries, clinical nurse specialists, rather than doctors, often manage these appointments. A previous review of studies had suggested that people are more likely to be satisfied with their treatment if it is provided by a nurse specialist rather than a doctor who specialised in these types of conditions (a rheumatologist).

But the review had found only four studies looking at this, which wasn’t enough to draw firm conclusions. To find out more, researchers in Norway looked at 68 people who’d been taking DMARDs for three months. They randomly divided them into two groups, to have regular 30-minute appointments with either a
nurse specialist or a rheumatologist. The people filled in questionnaires measuring their satisfaction with their care at the start of the study, and then again after nine and 21 months. The researchers then compared their responses, based on whether they saw nurse specialists or doctors.


People who saw nurse specialists were more satisfied with their care than people who saw doctors. And their satisfaction increased over the 21-month study. People were happier with nurse specialists in all of the areas of care that were measured, including:

  • the information provided at their appointments
  •  their access to care and its continuity
  •  their providers’ empathy (how well they seemed to understand and ‘relate to’ the patient and their needs),
    technical skill, and attitude towards them.

In contrast, people who met with doctors were less satisfied at the end of the study regarding the information provided, and their care access and continuity. There were no notable differences between the groups in people’s symptoms or in how they coped with their illness.


These findings should be reliable. This was a type of study called a randomised controlled trial, which is the best type of study for comparing different treatments. However, it’s worth noting that six rheumatologists, compared with only two nurse specialists, met with patients during the study. This means that people seeing doctors could potentially have met with a different rheumatologist at each of their appointments. This might partly explain why people seeing doctors were less happy with the continuity of their care.


These findings suggest that people taking DMARDs for inflammatory arthritis might be more satisfied with care if they see a clinical nurse specialist for their appointments, rather than a doctor. The study didn’t explore the reasons behind these findings.

However, a main focus of nurse specialists is to provide patient education – helping people to better understand and manage their illness. This focus, combined with advanced training in treating inflammatory arthritis, may uniquely prepare nurse specialists to provide effective, patient-centred care for people with these conditions. However, not all clinics have nurse specialists available for this type of monitoring and management. But if you are taking DMARDS for inflammatory arthritis and if trained nurses are available, you can talk to your doctor about who you would like to manage your treatment.

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Date summary prepared: June 2013

Summary based on research article published on: 7 February 2013

From: Koksvik, H. et al. Patient satisfaction with nursing consultations in a rheumatology outpatient clinic: a 21-month randomised controlled trial in patients with inflammatory arthritides. Ann Rheum Dis 2013;72:836-843 doi:10.1136/annrheumdis-2012-202296

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