New studies shared at the 2025 annual EULAR congress in Barcelona reinforce that position, highlighting the benefits that nurse-led care can bring for both patients and healthcare systems.
Nurse-led care and self-monitoring can both support treat-to-target (T2T) approaches.2,3 Combining self-monitoring with nurse support during the initiation of urate-lowering therapy in people with gout could help reduce physician visits and costs while maintaining or improving quality of care. Work shared by Jeffrey van der Ven looked at estimating the cost-effectiveness of nurse-led home monitoring of serum urate compared to usual management in secondary care using a decision-modelling approach. The modelled intervention involved specialised rheumatology nurses remotely supporting patients in stepwise dose adjustments using a T2T approach based on point-of-care testing for serum urate, which patients can perform at home. Usual care relied on the same T2T strategy with standard hospital-based laboratory measurements and routine rheumatologist visits. The findings showed home monitoring was cost-effective with a mean incremental net monetary benefit of €130. Improvements in health outcomes were modest, but compared to usual care the intervention saved time for rheumatologists due to task reallocation towards rheumatology nurses – with rheumatologists saving 42.7 minutes, while nurses spent an extra 51.2 minutes. This time saving could potentially allow rheumatologists to see more new patients. Future studies should focus on ways to reduce the nurse time needed while maintaining adherence – and automated feedback and risk stratification based on home monitored values might be a promising next step.
A clinic in the UK has been experimenting with using nurses to speed the time to biologic initiation for patients with inflammatory arthritis. Theresa May presenting findings from a weekly biologic group education clinic led by an experienced nurse practitioner – in place of individual face-to-face appointments. Each clinic has two groups of 3–4 patients, grouped according to the class of biologics. In a group appointment over 30 minutes, patients are informed of treatment benefits, risks and side effects, administration, and monitoring. A quality improvement project and audit included 28 patients, and showed that waiting times from treatment decision to the education appointment improved from 46 to 10 days after implementation of group education clinics. The weekly clinic capacity for biologic education has increased from 6 to 12–18 patients per clinic, with minimal impact on administrative burden. All patients reported that they found the sessions useful, interactive, and engaging, and were happy with the format – in particular the opportunity for peer support. When asked to score out of 10 (10=best), patients gave the overall quality of the session 9.85, and rated their confidence about biologic knowledge after the session as 9.42. The authors conclude that nurse-led biologic group education clinics are a feasible and effective intervention for reducing waiting times for patients starting biologic therapy, and can improve patient satisfaction.
Source
van der Ven J, et al. Cost-effectiveness of nurse-led home monitoring of serum uric acid values for gout patients in secondary care: a modelling study. Presented at EULAR 2025; OP0303.
Ann Rheum Dis 2025; DOI: 10.1136/annrheumdis-2025-eular.B3248.
Alcala TM, et al. Nurse-led Biologic Group Education Clinic for patients with inflammatory arthritis: A Quality Improvement Project. Presented at EULAR 2025; OP0118-HPR.
Ann Rheum Dis 2025; DOI: 10.1136/annrheumdis-2025-eular.C138.
References
1. 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 2020;79:61–8. DOI: 10.1136/annrheumdis-2019-215458.
2. Doherty M, et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet 2018;392(10156):1403–12. DOI: 10.1016/S0140-6736(18)32158-5.
3. Riches PL, et al. Evaluation of supported self-management in gout (GoutSMART): a randomised controlled feasibility trial. Lancet Rheumatol 2022;4(5):e320–8. DOI: 10.1016/S2665-9913(22)00062-5.
About EULAR
EULAR is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with rheumatic and musculoskeletal diseases (RMDs). EULAR aims to reduce the impact of RMDs on individuals and society, as well as improve RMD treatments, prevention, and rehabilitation. To this end, EULAR fosters excellence in rheumatology education and research, promotes the translation of research advances into daily care, and advocates for the recognition of the needs of those living with RMDs by EU institutions.
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