2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis.

To update the European League Against Rheumatism (EULAR) recommendations for the role of the nurse in the management of chronic inflammatory arthritis (CIA) using the most up to date evidence. The EULAR standardised operating procedures were followed. A task force of rheumatologists, health professionals and patients, representing 17 European countries updated the recommendations, based on a systematic literature review and expert consensus. Higher level of evidence and new insights into nursing care for patients with CIA were added to the recommendation. Level of agreement was obtained by email voting. The search identified 2609 records, of which 51 (41 papers, 10 abstracts), mostly on rheumatoid arthritis, were included. Based on consensus, the task force formulated three overarching principles and eight recommendations. One recommendation remained unchanged, six were reworded, two were merged and one was reformulated as an overarching principle. Two additional overarching principles were formulated. The overarching principles emphasise the nurse's role as part of a healthcare team, describe the importance of providing evidence-based care and endorse shared decision-making in the nursing consultation with the patient. The recommendations cover the contribution of rheumatology nursing in needs-based patient education, satisfaction with care, timely access to care, disease management, efficiency of care, psychosocial support and the promotion of self-management. The level of agreement among task force members was high (mean 9.7, range 9.6-10.0). The updated recommendations encompass three overarching principles and eight evidence-based and expert opinion-based recommendations for the role of the nurse in the management of CIA.

Nurses' roles in the management of chronic inflammatory arthritis: a systematic review.

In 2011 EULAR first published recommendations for the potential role of nurses in the management of patients with rheumatic diseases. To perform a literature update for the role of nurses in the management of chronic inflammatory arthritis (CIA) from 2010 to 2018. A systematic literature review (SLR) was performed according to the PRISMA guidelines, in accordance with the search strategies and eligibility criteria of the EULAR taskforce. The eligibility criteria were "inflammatory arthritis", "interventions undertaken by nurses" and "relevant outcomes to answer the research questions". Exclusion criteria were in itself contradictory outcomes, insufficient data, consideration if they did not clearly distinguish between nurses and health professionals or focused on chronic other than rheumatic diseases. Systematic reviews were classified as descriptive and excluded. Quality of selected trials was determined according to Oxford-levels of evidence 2009. A total of 48 articles and 10 abstracts were identified fulfilling the eligibility and exclusion criteria. Recommendation 1 has been well established in Europe so far. New evidence strengthens the recommendation 3, and-at least in part-recommendation 6. High evidence strengthens recommendation 4, especially for outpatients with low and stable disease activity. Some new evidence also exists for recommendations 7 and 8. This SLR reveals new evidence for the role of nurses in managing CIA patients since 2010, especially for RA-patients with low disease activity or in remission.

Survey on attitudes regarding EULAR recommendations for the role of nurses involved in medical care of patients with chronic inflammatory arthritis in Japan.

OBJECTIVE: We seek to evaluate the opinions of nurses and doctors in Japan regarding EULAR recommendations for nurses' roles in the management of chronic inflammatory arthritis. METHODS: This is a cross-sectional survey within Japan. We randomly selected nurses and doctors engaged in consultation of patients with rheumatoid arthritis (RA) and assessed their agreement and opinions on the feasibility of implementing EULAR recommendations, including potential barriers. RESULTS: 431 nurses and 128 doctors completed the questionnaire. For both nurses and doctors, levels of feasibility showed statistically significant lower results compared with those of agreement for all items. When compared between nurses and doctors, agreement showed no statistically significant differences, while nurses' answers were statistically significant lower for feasibility. Insufficient time, staff and knowledge, lack of established procedures and facilities, and lack of an education system for nurses were cited as barriers to the feasibility of implementing EULAR recommendations. CONCLUSIONS: This is the first survey within Japan evaluating opinions regarding EULAR recommendations for nurses' roles. We found that while agreement was high, feasibility was generally believed to be low. We recommend further research and collaboration between medical professionals in order to implement these recommendations in Japan.

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.

Caring for stoma patients with arthritis and mental incapacities.

Mental incapacities in the form of dementia, Parkinson's disease, Huntington's disease, and the physical incapacities of arthritis are difficult hurdles for an older patient who has to undergo stoma surgery, irrespective of the stoma being temporary or permanent. The loss of intellectual and physical function can cause significant deterioration in the patient's ability to carry out day-to-day activities and can also manifest itself in changes in social behaviour. Caring for these patients in the community will require the nurse to adjust the patient's care accordingly, and provide a holistic and more individualised care package that includes the support of the carer or spouse. This article discusses the ways in which community nurses can help the older stoma patient and carer.

Bisfosfonatos orales, denosumab y osteonecrosis de los maxilares / Oral bisphosphonates, denosumab and osteonecrosis of the jaws

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Chronic conditions in elders in assisted living facilities: associations with daily functioning, self-assessed health, and depressive symptoms.

BACKGROUND: The increasing life expectancy of older adults has prompted an increase in chronic conditions that may interfere with their daily living and impact physical and mental health. OBJECTIVES: This study examined associations between commonly reported chronic conditions, daily functioning, self-assessed health, and depressive symptoms of elders. METHODS/DESIGN: A secondary analysis of existing data from 314 elderly residents of 29 facilities was conducted. RESULTS: The most frequently reported conditions were arthritis (64%), hypertension (47%), and heart problems (35%). Elders who reported having all three of these most frequently reported conditions differed significantly from those who reported none or one of the three conditions (p<.001) on their perception of interference with daily functioning and self-assessed health. Although differences on depressive symptoms were found between groups defined by number and combinations of conditions, specific trends in the data were not detected. Elder's rating of interference of their chronic conditions on daily functioning was moderately associated with their self-assessed health (r=-.50, p<.001) and depressive symptoms (r=.41, p<.001). CONCLUSION: While chronic conditions may be unavoidable, assessing their comorbidity in elders is important for developing interventions to preserve their daily functioning and promote their optimal health.

Dissemination and evaluation of the European League Against Rheumatism recommendations for the role of the nurse in the management of chronic inflammatory arthritis: results of a multinational survey among nurses, rheumatologists and patients.

OBJECTIVES: The aims of this study were to disseminate, assess agreement with, assess the application of and identify potential barriers for implementation of the European League Against Rheumatism (EULAR) recommendations for the role of nurses in the management of chronic inflammatory arthritis (CIA) using a survey of nurses, rheumatologists and patients. METHODS: A Web-based survey was distributed across Europe and the USA using snowball sampling. Levels of agreement and application were assessed using a 0-10 rating scale (0 = none, 10 = full agreement/application). Reasons for disagreement and potential barriers to application of each recommendation were sought. Regional differences with respect to agreement and application were explored. RESULTS: In total, 967 nurses, 548 rheumatologists and 2034 patients from 23 countries participated in the survey. Median level of agreement was high in all three groups, ranging from 8 to 10 per recommendation. Median level of application was substantially lower, ranging from 0 to 8 per recommendation. Agreement and application were lowest in Eastern and Central Europe. The most commonly reported reasons for incomplete agreement were too many other responsibilities (nurses), doubts about knowledge of the nurse (rheumatologists) and fear of losing contact with the rheumatologist (patients). The most commonly reported barriers to the application were time constraints and unavailability of service. Rheumatologists responses suggested that nurses had insufficient knowledge to provide the recommended care. CONCLUSION: The EULAR recommendations for the role of nurses in the management of CIA have been disseminated among nurses, rheumatologists and patients across Europe and the USA. Agreement with these recommendations is high, but application is lower and differed across regions.

Long-term effects of a nurse-led group and individual patient education programme for patients with chronic inflammatory polyarthritis - a randomised controlled trial.

AIMS AND OBJECTIVES: To investigate the long-term effect of a nurse-led hospital-based patient education programme combining group and individual education for patients with chronic inflammatory polyarthritis. BACKGROUND: Patient education interventions have shown short-term effects, but few studies have investigated whether the effects are sustained for a longer period. DESIGN: Randomised controlled trial. METHODS: Patients with rheumatoid arthritis, psoriatic arthritis and unspecified polyarthritis were randomised to the intervention group (n = 71) or a waiting list (n = 70). Primary outcomes were as follows: Global Well-Being and the Arthritis Self-Efficacy Other Symptoms Subscale. Secondary outcomes were as follows: patient activation, physical and psychological health status, patients' educational needs and a Disease Activity Score (DAS28-3). RESULTS: The intervention group had a statistically significant higher global well-being than the controls after 12 months, mean change score 8·2 (95% CI, 1·6-14·8; p-value = 0·015), but not in the Arthritis Self-Efficacy Other Symptoms Subscale, mean change score 2·6 (95% CI, -1·8 to 7·1; p-value = 0·245). Within each group, analyses showed a statistically significant improvement in DAS28-3, mean change -0·3 (95% CI, -0·5 to -0·1; p-value = 0·001), in the intervention group from baseline to 12 months, but not in the controls. The controls had a statistically significant deterioration in the Arthritis Self-Efficacy Other Symptoms Subscale, mean change -5·0 (95% CI, -8·6 to -1·3; p-value = 0·008), Arthritis Impact Measurement Scales - 2 Social, mean change 0·3 (95% CI, 0·1-0·5; p-value = 0·008), and Hospital Anxiety and Depression Scale total, mean change 1·4 (95% CI, 0·3-2·5; p-value = 0·013). CONCLUSION: A combination of group and individual patient education has a long-term effect on patients' global well-being. RELEVANCE TO CLINICAL PRACTICE: Nurses should consider whether a combination of group and individual patient education for patients with chronic inflammatory polyarthritis is an alternative in their clinical practice. This combination is less time-consuming for the patients, and it includes the benefit of group learning in addition to focusing on patient's individual educational needs.

Applicability of the EULAR recommendations on the role of the nurse in the management of chronic inflammatory arthritis in Portugal.

OBJECTIVES: To evaluate the level of agreement and applicability of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis in Portugal. METHODS: Nurses from all Portuguese rheumatology centers were invited to fill-in a questionnaire addressing the level of agreement (1=strongly disagree to 5=strongly agree) and the level of confidence (1=no confidence to 5=complete confidence) in the applicability of each of the recommendations. Comparisons were established between subgroups of nurses. RESULTS: A total of 75 nurses (85% female; mean (SD) of 3.9 (4.1) years of practice, 32% with some type of training in rheumatology) participated in the study. The mean level of agreement with the recommendations was 4.8 (SD 0.3). The level of confidence in their full applicability was 3.6 (SD 0.8). Significantly more nurses with rheumatology training totally agreed with recommendations 7 (88% vs 73%, p=0.03) and 3 (96% vs 65% p=0.04) and were fully confident in the applicability of recommendations 2, 3, 7, 9 and 10, comparing with those without specific training. CONCLUSIONS: The overall level of agreement with EULAR recommendations among Portuguese nurses is high, although rheumatology does not exist as a nursing specialty. Agreement and confidence in the applicability of these recommendations is higher among nurses with specific training, underlining the importance of continuous education for future commitment.

Caring for people with arthritis and a stoma.

It is understood that 10 million people currently live with arthritis and that there are two main types: osteoarthritis and rheumatoid arthritis (Arthritis Care, 2013). As the numbers of people with arthritis grows, and the population ages, it is likely that nurses may be presented with increasing numbers of people who require advice, not only when they have their stoma fashioned, but later in their life. The purpose of this article is to consider the impact of arthritis upon stoma care and make practical suggestions for stoma management. Sources of further help and information for people living with a stoma and arthritis have also been included. It is hoped that by reading this article the nurse will be more familiar with the impact that arthritis may have on a person with a stoma and how they can be assisted to manage as independently as possible.

A closer look at hand and wrist complaints.

Hand or wrist pain is a common complaint in primary care. This pain can be very disabling and can significantly impair a person's quality of life. With the appropriate clinical knowledge and skills, nurse practitioners can effectively evaluate, diagnose, and treat many of the common hand and wrist complaints seen in primary care.

The educational needs of nurses and allied healthcare professionals caring for people with arthritis: results from a cross-sectional survey.

AIM: The purpose of the present study was to identify the educational needs of rheumatology nurses and allied healthcare professionals (AHPs) working with people with osteoarthritis (OA) and rheumatoid arthritis (RA). METHODS: A cross-sectional national online survey was carried out. RESULTS: The survey was completed by 162 health care practitioners. Seventy-one per cent of respondents had the knowledge and skills to manage the care of a person with RA. The elements of care for which the respondents were either unsure or did not have the necessary knowledge and skills related to providing advice on exercise (37%) and pain medication (30%) to people with RA. There was a consistent tendency for respondents to be less confident in their knowledge and skills when caring for people with OA, with respondents reporting that they were either unsure or did not have the necessary knowledge and skills to advise on appropriate exercise (61%), or medication for the management of pain (45%) or the management of ongoing care (51%). CONCLUSIONS: Current and future educational programmes on RA and OA management should provide nurses and AHPs with the opportunity to develop knowledge and skills in providing advice on exercise and pain medication.

Caregiving appraisal and disease activity in early inflammatory arthritis.

OBJECTIVE: The caregiving process accompanying inflammatory arthritis can be stressful to both caregivers and care recipients. In this study, we examined how caregiving involvement and caregiving appraisal as perceived by both patients and their caregiving spouses relate to disease activity and mental health of patients in early inflammatory arthritis. METHODS: Patients in the early phase (> 6 weeks, <18 months duration) of inflammatory arthritis were recruited from a larger early inflammatory arthritis registry, which recorded sociodemographic data and disease characteristics. Disease activity was measured with the Disease Activity Score in 28 joints (DAS28). Current depressive symptoms were measured using the Center for Epidemiologic Studies - Depression Mood Scale. Patient and spouse perceived caregiving involvement and caregiving appraisal were assessed using the Caregiving Involvement Questionnaire and Caregiving Appraisal Scale, respectively. RESULTS: The study sample consisted of 73 patients living with spouse. Mean age was 54 years, 64.4% were women and mean illness duration was 7.48 months. Patients' positive caregiving appraisal was associated with less disease activity (DAS28) (p = 0.003) and less total depressive mood (p < 0.001). In multivariate analysis, patients' appraisal of the caregiving context was negatively associated with disease activity (DAS28) after controlling for caregiving involvement and depression (p = 0.035). CONCLUSION: This study indicates that, in early inflammatory arthritis, patients' caregiving appraisal might be important to consider when assessing disease activity. Clinicians are encouraged to include both patients and their spouse caregivers in interventions.

Intervenções de enfermagem para o cuidado de pacientes com artrite: revisão integrativa da literatura / Nursing interventions for the care of patients with arthritis: an integrative review / Intervenciones de enfermería para el cuidado de pacientes con artritis: revisión integradora

Esta revisão integrativa buscou analisar a produção científica relacionada aos cuidados de enfermagem para pacientes com artrite. Foram incluídos 12 estudos experimentais, randomizados e controlados, publicados nas bases de dados CINAHL, MEDLINE, SciELO e LILACS, utilizando os descritores controlados "arthritis" e "nursing". Os resultados apontaram a efetividade de musicoterapia, estimulação elétrica neuromuscular, toque terapêutico e imagem guiada associada a relaxamento, para o tratamento da dor. Ser atendido por enfermeira especialista aumentou a satisfação com o atendimento, melhorou o impacto da doença e aumento a procura por serviços de saúde. Programas educativos específicos para portadores de artrite estimularam a prática de exercícios físicos e aqueles direcionados a pessoas com problemas crônicos em geral mostraram-se efetivos para controlar a dor e a incapacidade funcional. Concluímos que existe um conjunto de intervenções que podem subsidiar a prática de enfermagem baseada em evidências junto aos idosos com artrite.

This integrative review aimed to analyze the scientific literature related to nursing care for patients with arthritis. Twelve experimental studies were included, randomized and controlled, published in CINAHL, MEDLINE, SciELO and LILACS databases, using the controlled keywords "arthritis" and "nursing". The results indicated the effectiveness of music therapy, neuromuscular electrical stimulation, therapeutic touch and guided imagery associated with relaxation, for the treatment of pain. Being treated by a specialist nurse increased satisfaction with care, improved the impact of the disease and increased the demand for health services. Specific educational programs for people with arthritis stimulated the practice of physical exercises and those targeted to people with chronic conditions in general were effective to control pain and functional disability. We conclude that there is a set of interventions that can support the practice of evidence-based nursing for the elderly people with arthritis.

Esta revisión integradora tuvo como objetivo analizar la literatura científica relacionada con los cuidados de enfermería en pacientes con artritis. Se incluyeron 12 estudios experimentales, los ensayos controlados aleatorios, publicados en las bases de datos CINAHL, MEDLINE, LILACS y SciELO, utilizando las palabras clave controladas "artritis" y "enfermería". Los resultados indican la efectividad de la musicoterapia, la estimulación eléctrica neuromuscular, toque terapéutico y la imaginación guiada asociada con la relajación, para el tratamiento del dolor. Ser tratado por una enfermera especialista aumentó la satisfacción con la atención, la mejora del impacto de la enfermedad y aumentar la demanda de servicios de salud. Los programas específicos de educación para personas con artritis estimulado ejercicios físicos y los destinados a las personas con enfermedades crónicas en general son eficaces para controlar el dolor y la discapacidad funcional. Llegamos a la conclusión de que existe un conjunto de intervenciones que pueden apoyar la práctica de la enfermería basada en la evidencia para los ancianos con artritis.

EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis.

OBJECTIVES: The authors aim to develop European League Against Rheumatism recommendations for the role of the nurse in the management of patients with chronic inflammatory arthritis, to identify a research agenda and to determine an educational agenda. METHODS: A task force made up of a multidisciplinary expert panel including nurses, rheumatologists, occupational therapist, physiotherapist, psychologist, epidemiologist and patient representatives, representing 14 European countries, carried out the development of the recommendations, following the European League Against Rheumatism standardised operating procedures. The task force met twice. In the first meeting, the aims of the task force were defined, and eight research questions were developed. This was followed by a comprehensive, systematic literature search. In the second meeting, the results from the literature review were presented to the task force that subsequently formulated the recommendations, research agenda and educational agenda. RESULTS: In total, 10 recommendations were formulated. Seven recommendations covered the contribution of nurses to care and management: education, satisfaction with care, access to care, disease management, psychosocial support, self-management and efficiency of care. Three recommendations focused on professional support for nurses: availability of guidelines or protocols, access to education and encouragement to undertake extended roles. The strength of the recommendations varied from A to C, dependent on the category of evidence (1A-3), and a high level of agreement was achieved. Additionally, the task force agreed upon 10 topics for future research and an educational agenda. CONCLUSION: 10 recommendations for the role of the nurse in the management of chronic inflammatory arthritis were developed using a combination of evidence-based and expert consensus approach.

[Nursing interventions for the care of patients with arthritis: an integrative review]. / Intervenções de enfermagem para o cuidado de pacientes com artrite: revisão integrativa da literatura.

This integrative review aimed to analyze the scientific literature related to nursing care for patients with arthritis. Twelve experimental studies were included, randomized and controlled, published in CINAHL, MEDLINE, SciELO and LILACS databases, using the controlled keywords "arthritis" and "nursing". The results indicated the effectiveness of music therapy, neuromuscular electrical stimulation, therapeutic touch and guided imagery associated with relaxation, for the treatment of pain. Being treated by a specialist nurse increased satisfaction with care, improved the impact of the disease and increased the demand for health services. Specific educational programs for people with arthritis stimulated the practice of physical exercises and those targeted to people with chronic conditions in general were effective to control pain and functional disability. We conclude that there is a set of interventions that can support the practice of evidence-based nursing for the elderly people with arthritis.