The convenience of family and community health nurses-led care for the treatment of rheumatic diseases with biological or targeted synthetic disease-modifying antirheumatic drugs. The experience of Valcamonica, Italy.

OBJECTIVE

To investigate the role of family and community health nurses (FCHNs) in monitoring the safety and efficacy of biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) in chronic rheumatic diseases.

METHODS

We followed 141 consecutive patients (median age 59 years; 69% female) with autoimmune diseases, mainly rheumatoid arthritis (RA; 46.1%) and spondyloarthritis (SpA; 46.8%), receiving bDMARDs or tsDMARDs from January 2024 to March 2025 ("IFER" protocol). FCHNs monitored treatment safety and efficacy using patient-reported outcomes every 2 months and composite disease activity indices at 6 and 12 months. Patients with adverse events, disease complications, or high disease activity were referred to the rheumatologist for treatment reassessment. Major adverse events, healthcare costs, and rheumatology visits were compared with data from 2021-2023.

RESULTS

No significant difference in major adverse events was observed compared with previous years (deaths: 2 vs. 3; hospitalizations: 9 vs. 25; emergency room visits: 3 vs. 12; p=ns). Agreement between rheumatologists and FCHNs in disease activity assessment was moderate overall (Cohen's κ=0.54±0.06), good in RA (κ=0.65±0.08), and poor in SpA (κ=0.29±0.10). Per-capita annual costs decreased significantly (€5164 vs. €4590; p<0.001), as did rheumatology visits per patient/year (2.16 vs. 1.67; p<0.001). First-line treatment significantly increased during the IFER period (Log-rank p<0.001).

CONCLUSIONS

FCHN-led monitoring of patients receiving bDMARDs or tsDMARDs appears feasible, safe, and cost-effective. Further studies are warranted to confirm these findings.