***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND AIM The concept of nurse-led care ( NLC ) was not familiar in China . This study was design ed to evaluate the clinical effectiveness and cost-effectiveness of NLC versus rheumatologist-led care ( RLC ) in Chinese patients with rheumatoid arthritis ( RA ) . METHODS Patients of either gender ( aged ≥18 years ) with RA were enrolled at Wenhai Central Hospital , China ( January 2015 to December 2015 ) . The participants were then r and omized to NLC or RLC . Outcomes of both the groups were compared in terms of effectiveness by measuring the Disease Activity Score 28 , visual analogue scores pertaining to pain and fatigue , and duration of morning stiffness . Costs associated with re source use for RA were assessed and compared between both groups . RESULTS A total of 214 RA patients in 2 groups ( n = 107 in each group ) were enrolled and analysed . Improvements in clinical outcomes ( disease activity , pain , fatigue , and morning stiffness ) over 12 months were significantly greater in the NLC group compared to RLC ( P < 0.001 ) . Overall , costs associated with re source use were higher in the RLC group compared to the NLC group ( P < 0.05 ) . CONCLUSIONS Our preliminary finding suggested that RA patients managed by NLC compared to RLC may have better clinical outcomes and more cost-effective care in China Aim To compare and evaluate the treatment outcomes of a nurse-led rheumatology clinic and a rheumatologist-led clinic in patients with low disease activity or in remission who are undergoing biological therapy .  Background Patients with chronic inflammatory arthritis treated with biological therapy  are usually monitored by rheumatologists . Nurse-led rheumatology clinics have been proposed in patients with low disease activity or in remission . Design R and omized controlled trial . Methods A 12-month follow-up trial was conducted between October 2009 and August 2011 , where 107 patients were r and omized into two groups with a 6-month follow-up to a nurse-led rheumatology clinic based on person-centred care ( intervention group ; n = 53 ) or to a rheumatologist-led clinic ( control group ; n = 54 ) . The hypothesis was that the nurse-led clinic outcomes would not be inferior to those obtained from a rheumatologist-led clinic at the 12-month follow-up . The primary outcome was disease activity measured by Disease Activity Score 28 . Results A total of 47 patients in the intervention group and 50 in the control group completed the 12-month trial . The trial revealed no statistically significant differences between groups in mean change of Disease Activity Score 28 , Visual Analogue Scales for pain , the Health Assessment Question naire , satisfaction with or confidence in obtaining rheumatology care . Conclusion Patients with stable chronic inflammatory arthritis undergoing biological therapy  could be monitored by a nurse-led rheumatology clinic without difference in outcome as measured by the Disease Activity Score 28 Objective To determine the outcome and cost-effectiveness of nurse-led care in the community for people with rheumatoid arthritis ( RA ) . Design Non-r and omised pragmatic study . Setting Primary ( 7 primary care practice s ) and secondary care ( single centre ) in the UK . Methods In a single area , pragmatic non-r and omised study , we assessed the outcome , cost-effectiveness of community-based nurse-led care ( NLC ) compared with rheumatologist-led outpatient care ( RLC ) .  Participants were 349 adults ( 70 % female ) with stable RA assessed at baseline , 6 and 12 months . In the community NLC arm there were 192 participants . Outcome was assessed using Stanford Health Assessment Question naire ( HAQ ) . The economic evaluation ( healthcare perspective ) estimated cost relative to change in HAQ and quality -adjusted life years ( QALY ) derived from EQ-5D-3L . We report complete case and multiple imputation results from regression analyses . Results The demographics and baseline characteristics of patients in the community group were comparable to those under hospital care apart from use of biological disease-modifying antirheumatic drugs ( DMARDS ) , which were adjusted for in the analysis . The mean incremental cost was estimated to be £ 224 less for RLC compared to the community NLC , with wide CIs ( CI –£213 to £ 701 , p=0.296 ) . Levels of functional disability were not clinical ly significantly higher in the community NLC group : HAQ 0.096 ( 95 % CI −0.026 to 0.206 ; p=0.169 ) and QALY 0.023 ( 95 % CI −0.059 to 0.012 ; p=0.194 ) . Conclusions The results suggest that community care may be associated with non-significant higher costs with no significant differences in clinical outcomes , and this suggests a low probability that it is cost-effective Background Recommendations for rheumatology nursing management of chronic inflammatory arthritis ( CIA ) from European League Against Rheumatism ( EULAR ) states that nurses should take part in the monitoring patients ’ disease and therapy in order to achieve cost savings . The aim of the study was to compare the costs of rheumatology care between a nurse-led rheumatology clinic ( NLC ) , based on person-centred care ( PCC ) , versus a rheumatologist-led clinic ( RLC ) , in monitoring of patients with CIA undergoing biological therapy . Methods Patients with CIA undergoing biological therapy ( n = 107 ) and a Disease Activity Score of 28 ≤ 3.2 were r and omised to follow-up by either NLC or RLC . All patients met the rheumatologist at inclusion and after 12 months . In the intervention one of two annual monitoring visits in an RLC was replaced by a visit to an NLC . The primary outcome was total annual cost of rheumatology care . Results A total of 97 patients completed the RCT at the 12 month follow-up . Replacing one of the two annual rheumatologist monitoring visits by a nurse-led monitoring visit , result ed in no additional contacts to the rheumatology clinic , but rather a decrease in the use of re sources and a reduction of costs . The total annual rheumatology care costs including fixed monitoring , variable monitoring , rehabilitation , specialist consultations , radiography , and pharmacological therapy , generated € 14107.7 per patient in the NLC compared with € 16274.9 in the RCL ( p = 0.004 ) , giving a € 2167.2 ( 13 % ) lower annual cost for the NLC . Conclusions Patients with CIA and low disease activity or in remission undergoing biological therapy can be monitored with a reduced re source use and at a lower annual cost by an NLC , based on PCC with no difference in clinical outcomes . This could free re sources for more intensive monitoring of patients early in the disease or patients with high disease activity . Trial registration The trial is registered as a clinical trial at the Clinical Trials.gov ( NCT01071447 ) . Registration date : October 8 , 2009 OBJECTIVE To explore the impact from different types of outpatient care , demographic and disease related variables on self-efficacy beliefs ( SE ) in patients with established rheumatoid arthritis ( RA ) after completing an educational program . METHODS 287 adult RA out patients with low disease activity and moderate physical disability from two Danish rheumatology clinics were r and omized for follow-up care . ( 1 ) planned rheumatologist 's consultations , ( 2 ) a shared care model without planned consultations , ( 3 ) planned nursing consultations . The participants ' SE were assessed by the Danish versions of the rheumatoid arthritis self-efficacy question naire ( RASE ) and the arthritis self-efficacy scale ( ASES ) . Data were collected at baseline , 3 months and one-year follow up and were explored in r and om intercept models . RESULTS Following an educational programme the nursing group increased or stabilized their SE during the first year compared to the medical and the shared care group . SE in the shared care group did not differ significantly from the medical group . No difference between the groups was seen in disease activity at any time . CONCLUSION Nursing consultations provide opportunities for maintenance of the patients ' SE after patient education . PRACTICE IMPLICATION S Implementation of nursing consultations as part of follow-up care in patients with stable RA is recommended Objectives Rheumatoid arthritis ( RA ) patients are at an increased risk of developing comorbid conditions . A close monitoring of the disease targeting a status of low disease activity is associated with a better outcome . The aim of this trial was to evaluate the impact of a nurse-led programme on comorbidities and the impact of patient self- assessment of disease activity on the management of RA . Methods We enrolled 970 patients ( mean age 58 years , 79 % women ) in a prospect i ve , r and omised , controlled , open-label , 6-month trial . In the comorbidity group ( n=482 ) , the nurse checked comorbidities and sent the programme results to the attending physicians . In the self- assessment group ( n=488 ) , the nurse taught the patient how to calculate his/her Disease Activity Score which had to be reported on a booklet to be shared with the treating rheumatologist . The number of measures taken for comorbidities and the percentage of patients recording a change ( initiation , switch or increased dose ) in  disease-modifying antirheumatic drugs ( DMARDs ) in the 6 months follow-up period of the study defined the outcomes of the trial . Results The number of measures taken per patient was statistically higher in the comorbidity group : 4.54±2.08 versus 2.65±1.57 ( p<0.001 ) ; incidence rate ratio : 1.78 ( 1.61–1.96 ) and DMARD therapy was changed more frequently in the self- assessment group : 17.2 % versus 10.9 % ( OR=1.70 ( 1.17 ; 2.49 ) , p=0.006 ) . Conclusions This study demonstrates the short-term benefit of a nurse-led programme on RA comorbidity management and the impact of patient self- assessment of disease activity on RA treatment intensification . Trial registration number NCT # 01315652 Objectives The Educational Needs Assessment Tool ( ENAT ) is a self-completed question naire , which allows patients with arthritis to prioritise their educational needs . The aim of this study was to evaluate the effects of needs-based patient education on self-efficacy , health outcomes and patient knowledge in people with rheumatoid arthritis ( RA ) . Methods Patients with RA were enrolled into this multicentre , single-blind , parallel-group , pragmatic r and omised controlled trial . Patients were r and omised to either the intervention group ( IG ) where patients completed ENAT , responses of which were used by the clinical nurse specialist to guide patient education ; or control group ( CG ) in which they received patient education without the use of ENAT . Patients were seen at weeks 0 , 16 and 32 . The primary outcome was self-efficacy ( Arthritis Self Efficacy Scale (ASES)-Pain and ASES-Other symptoms ) . Secondary outcomes were health status ( short form of Arthritis Impact Measurement Scale 2 , AIMS 2-SF ) and patient knowledge question naire-RA . We investigated between-group differences using analysis of covariance , adjusting for baseline variables . Results A total of 132 patients were recruited ( IG=70 and CG=62 ) . Their mean ( SD ) age was 54 ( 12.3 ) years , 56 ( 13.3 ) years and disease duration 5.2 ( 4.9 ) years , 6.7 ( 8.9 ) years for IG and CG , respectively . There were significant between-group differences , in favour of IG at week 32 in the primary outcomes , ASES-Pain , mean difference ( 95 % CI ) −4.36 ( 1.17 to 7.55 ) , t=−2.72 , p=0.008 and ASES-Other symptoms , mean difference ( 95 % CI ) −5.84 ( 2.07 to 9.62 ) , t=−3.07 , p=0.003 . In secondary outcomes , the between-group differences favoured IG in AIMS 2-SF Symptoms and AIMS 2-SF Affect . There were no between-group differences in other secondary outcomes . Conclusions The results suggest that needs-based education helps improve patients ’ self-efficacy and some aspects of health status . Trial registration number IS RCT N51523281 AIM To evaluate the effects of a self-care promoting problem-based learning programme for people with rheumatic diseases in terms of health-related quality of life , empowerment , and self-care ability . BACKGROUND Individuals with rheumatoid arthritis express a great need for education and support in adapting to the disease , but the average qualities of studies about patient education interventions are not high . There is no evidence of long-term benefits of patient education . DESIGN R and omized controlled trial . METHODS A r and omized controlled design was selected with test at baseline , 1-week and 6-month post- interventions after completed the 1-year programme . The tests consisted of validity and reliability tested instruments . The participants were r and omly assigned in spring 2009 to either the experimental group ( n = 54 ) or the control group ( n 
    Output:
    
High evidence strengthens recommendation 4 , especially for out patients with low and stable disease activity .
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