The role of the nurse in inflammatory arthritis

Bech B, et al. 2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Ann Rheum Dis 2019; 79 (1) 61-68. doi:10.1136/annrheumdis-2019-215458

Introduction
Nurses play an important role in caring for people with arthritis. They are often the persons that assist a patient during clinic appointments. The nurse role has changed in modern clinics. Nurses may now perform some tasks that used to be done by doctors. Nurse specialists trained in rheumatology are able to examine the joints, give patient education and support, give injections, and recommend and prescribe medicines. However, the role for nurses can differ between different countries in Europe.

EULAR recommendations give advice to doctors, nurses and patients about the best way to treat and manage arthritic inflammatory rheumatic conditions. EULAR has updated its recommendation on the role of nurses in the treatment and care of people with arthritis. This is a group of conditions where the joints
become stiff, swollen and painful. The inflammation is caused by the body’s natural defence system attacking the body’s own tissues. Inflammatory arthritis includes rheumatic diseases, such as rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis.

Doctors, nurses, other health professionals and patients worked together to develop the recommendations. The patients in the team ensured that the patient’s point of view was included. The authors looked at the evidence on medical and non-medical interventions undertaken by nurses.

What do we already know?
The role of nurses has changed over the years. Nowadays, specially trained nurses are able to lead clinics. They manage people with inflammatory arthritis, including monitoring disease, treatment and side-effects. Nurses also monitor how diseases affect a person’s daily life, and how well they can participate in various work and social activities and provide support accordingly. Nurses also keep an eye on how a person’s disease affects their mental well-being.

EULAR recommendations published in 2012 on the role of the nurse in treatment and care for people with inflammatory arthritis have now been updated.

What do the recommendations say?
In total, there are three overarching principles and eight recommendations. The main principles say that firstly, rheumatology nurses are part of a healthcare team, and secondly that they provide evidence- based care. The third principle says that nurses must base this on shared decision-making with the patient.

Each recommendation is based on available scientific evidence or expert opinion. The more stars a recommendation has the stronger the evidence is.

One star (*) means there is very limited or no scientific evidence, but significant expert opinion.
Two stars (**) means it is a weak recommendation with some scientific evidence and significant expert opinion.
Three stars (***) means it is a strong recommendation with quite a lot of scientific evidence and expert opinion.
Four stars (****) means it is a strong recommendation supported with a lot of scientific evidence and expert
opinion

 People with chronic inflammatory arthritis should always be able to speak to a nurse to get education targeted to their needs about their disease and its management.****
Nurses can give people the right education for their personal needs. Education helps people to understand their disease and how it is treated. Education can also help people to manage their life
with a long-term disease.
• Nurse consultations can improve how satisfied people are with their care.****
Being satisfied with care is important. People who are satisfied with their care tend to feel well cared for. Nurses tend to have a less factual however supportive and continuing relationship. This adds to
people feeling more secure and confident with nurses than doctors.
 People should be able to get in touch with a nurse for support when they need it.****
Inflammatory arthritis can be unpredictable, and people may need extra support from time to time. Being able to get in touch with a nurse for help and support can help people to manage their disease
better. This might be by telephone or through the internet, rather than in person.
• Nurses aim to control their patients’ disease activity, reduce symptoms and improve outcomes. This will lead to cost-effective care.****
Nurses are one part of a program that aims to control and manage people’s disease. Nurses help to reduce people’s symptoms and improve well-being and quality of life. If the disease is well managed,
it can also help to reduce costs to the healthcare service.
• Nurses should address mental health and social issues to reduce anxiety and depression.****
People with arthritis often experience distress, anxiety and depression. Nurses can help to identify these problems and refer people for specialist treatment or counselling if they need it.
• Nurses should support people to manage their own disease and take charge of their own life.****
Helping people to self-manage includes education and advice about their disease and its treatment. Nurses can give people support for any lifestyle changes that might be needed. Nurses can also
help to build people’s belief in their own ability to manage specific problems.
 Nurses should be up-to-date on the current rheumatology topics.***
All nurses working with people with inflammatory arthritis should be up-to-date with new information about the best way to take care of the needs of their patients. This includes information about
medicines, treatment strategies, lifestyle and physical activity advice, and any personal concerns people may have.
• Nurses should be encouraged to take on more active roles once they have completed the proper training according to their national regulations.****
Giving nurses roles with more responsibility can benefit people with inflammatory arthritis. Patients often appreciate being looked after by a nurse who has the skills to deal with different aspects of their disease. Nurses should be encouraged to take on these roles if they have the right skills.

Summary
Overall, the recommendations say that it is important to involve nurses in the care of people with Inflammatory arthritis. They also emphasize the importance of education and training for nurses who manage and care for people with inflammatory arthritis.

If you have access to a nurse with special training in rheumatology you have a big advantage. You will be able to work together to manage your disease and get the best possible results from treatment. If you have an inflammatory arthritis, these recommendations will give you some guidance on what to expect from clinics run by nurses, or from any nurse specialists who work with you.

If you have any questions or concerns about your disease or your medication, you should speak to a health
professional involved in your care.

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