NEW YORK (Reuters Health)—Self-monitoring of methotrexate therapy may curb healthcare utilization in rheumatoid arthritis (RA) and psoriatic arthritis, according to a new trial.
The study indicates “that this novel model of care led to significant reductions in outpatient visits to the (clinical nurse specialist) and a reduction in visits to the GP, while maintaining the regularity with which patients saw their rheumatologist,” researchers report in Annals of the Rheumatic Diseases, online Aug. 19.
Treatment of arthritis has become increasingly complex, necessitating intensive monitoring and frequent follow-up visits, Dr. Stanton Newman of the School of Health Sciences in London and colleagues noted in their report.
The team sought to determine if patient self-monitoring of symptoms and blood tests while being treated with disease-modifying antirheumatic drugs (DMARDs) would cut the number of clinic visits.
The study was a single-center, randomized controlled trial involving 100 patients on a stable dose of methotrexate for either psoriatic arthritis or RA. Each participant received training on laboratory result interpretation and when to notify their designated clinical nurse specialist (CNS).
The control group received standard follow-up care with laboratory tests every four to six weeks, rheumatologist appointment every six months, and nurse visits every three months. All laboratory studies were independently reviewed by the nurse and researcher for safety purposes.
Patients who self-monitored had fewer visits to the clinical nurse specialist (30 vs. 66, p<0.0001) and to the general practitioner (29 vs. 47, p=0.07), but nearly as many visits to the rheumatologist (96 vs. 103, p=0.23).
They also showed improvement in the ability to appropriately initiate care (from 65.4% of all decisions to 89.1% over six weeks).
There were no significant differences in response to treatment (p=0.77) or levels of fatigue, pain, disability, or psychosocial factors between the two groups.
In the intervention group, two participants were unable to safely and accurately interpret the laboratory results and initiate care and thus were returned to standard care. Therefore, the authors note that a pilot phase of the self-monitoring program may be needed for each patient.
“It is reassuring that an intervention that required patients to pay closer attention to their illness and reduced unnecessary healthcare visits did not have a detrimental impact on patients’ psychosocial well-being,” the researchers write.
Dr. Newman did not respond for comment.
