Incorporating motivational interviewing into rheumatology care.

Deborah Palmer, Advanced Nurse Practitioner, North Middlesex University Hospital, and Yasser El Miedany, Consultant Rheumatologist, discuss ways to close the gap between disease control and patient empowerment.

Nurses' Role in Cardiovascular Risk Assessment and Management in People with Inflammatory Arthritis: A European Perspective.

INTRODUCTION: Cardiovascular risk (CVR) assessment and management in patients with inflammatory arthritis (IA) is recommended but European nurses' involvement in this role has not been well studied. AIM: The aim of the present study was to explore European nurses' role in assessing and managing CVR, in order to suggest topics for practice development and research in this area regarding persons with IA. METHODS: We searched Embase, Cinahl, Cochrane, PsycInfo and PubMed databases and included European articles from the past ten years if they described how nurses assess and/or manage CVR. In addition to the systematic review, we provided case studies from five different countries to illustrate national guidelines and nurses' role regarding CVR assessment and management in patients with IA. RESULTS: Thirty-three articles were included. We found that trained nurses were undertaking CVR assessment and management in different settings and groups of patients. The assessments include blood pressure, body mass index, waist circumference, glucose and lipid-profile, adherence to medication and behavioural risk factors (unhealthy diet, physical inactivity, alcohol and smoking). Different tools were used to calculate patients' risk. Risk management differed from brief advice to long-term follow-up. Nurses tended to take a holistic and individually tailored approach. Clinical examples of inclusion of rheumatology nurses in these tasks were scarce. CONCLUSION: Nurses undertake CVR assessment, communication and management in different types of patients. This is considered to be a highly relevant task for rheumatology nursing, especially in patients with IA. Further studies are needed to assess patients' perspective, effectiveness and cost-effectiveness of nurse-led CVR. Copyright © 2015 John Wiley & Sons, Ltd.

Treat-to-target: a tailored treatment approach to rheumatoid arthritis.

In contrast to articles and books written about rheumatoid arthritis (RA) two or more decades ago that largely focused on 'coping' with the disease, there have been significant developments in the treatment of RA over the past 10 years. Patients can now be diagnosed and treated and expect to live functional lives, with less likelihood of experiencing the associated joint damage and disability. An important goal of RA therapy has shifted to initiate treatment early and aggressively, with frequent assessment and a target to achieve remission as quickly as possible. This 'treat-to-target' concept has been endorsed to maximise long-term health-related quality of life through control of symptoms, prevention of structural damage, normalisation of function and social participation. This article will look at therapies and strategies for the treatment of RA. It will also discuss a treatment algorithm for rheumatoid arthritis tailored to the individual patient's disease activity status.

Rheumatology helpline: challenges in the biologic therapy era.

For rheumatology patients, telephone helplines can provide rapid access to management, advice, information and support. In many cases, the provision of a telephone helpline reflects an attempt to make care more flexible and patient-based. The 'direct' mode advice delivery can only be informally compared with the traditional route of patient access to advice, which often travelled a complex route via overworked medical secretaries or receptionists toward the final destination of medical staff, sometimes engaged in other activities. This article will discuss the challenges facing the rheumatology helpline and how these can be tackled.

Self-helplessness in arthritis: an important but overlooked index.

The recent introduction of patient-reported outcome measures (PROMs) assessment into rheumatology practice has changed the way patients suffering from inflammatory arthritis are assessed. This article describes a cross-sectional study of 102 rheumatoid arthritis (RA) patients that was undertaken to evaluate the construct of helplessness in patients with RA, its correlation with other disease activity parameters, and its sensitivity to change following biologic therapy. The study also set out to explore the possibility of including a self-helplessness measurement, using the modified Rheumatology Attitude Index (mRAI), as part of the holistic patient assessment in standard clinical practice. Assessment of self-helplessness was shown to be significantly correlated with both psychological as well as functional status measures. The mRAI index is a highly useful and predictive tool for clinical use that is responsive to change in the patients' clinical condition. As part of the PROMs questionnaire, this scale can be applied in a manner similar to other indicators of disease activity status, and is as easy to administer and interpret in standard clinical practice.

Biological nurse specialist: goodwill to good practice.

The extensive use of biological agents in recent years for the treatment of rheumatological diseases has required a steep learning curve for the specialist nurses who manage and work in this specialty. Safe prescribing of biological therapies requires good infrastructure and specialist nursing personnel. With additional training, the specialist nurse may take responsibility for a number of tasks in the patient pathway including screening, treatment administration, patient education, prescription coordination for home drug delivery, patient support, monitoring and data collection. Biological treatment is becoming more widely used in several specialities, in particular gastroenterology, dermatology and ophthalmology. Since 2002, rheumatology specialist nurses have taken the lead in assessment and providing biologic therapy, not only for patients suffering from rheumatic diseases but also for those with immune-mediated inflammatory disorders. The unique nature and variable safety profiles of these agents led to the development of immune-mediated inflammatory disease infusion (IMID) centres and highlighted the importance of having biological specialist nurses. This article will discuss the evolution of the IMID/biologic specialist nurse role and how IMID services started with goodwill from the rheumatology nurse specialists to develop into a main component of the holistic approach to care.