Article

Safety and patient satisfaction of infliximab administration in an extramural setting supervised by a rheumatology specialist nurse

Maastricht University, Maestricht, Limburg, Netherlands
Annals of the Rheumatic Diseases (Impact Factor: 9.27). 03/2006; 65(2):276. DOI: 10.1136/ard.2005.036566
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    ABSTRACT: The literature shows that more than 30% of the patients with fibromyalgia feel that their symptoms are not managed well. In addition, care for patients with rheumatoid arthritis is not consistent with guidelines for early, aggressive treatment and access to care is not optimal. My thesis describes our research with regard to several activities for care improvement and includes 6 peer reviewed publications. Part I of the thesis focuses on fibromyalgia. (Cost) effectiveness of a multidisciplinary intervention with aftercare (MD) for recently diagnosed patients was assessed in a randomised controlled trial comparing the results of the intervention with aerobic exercise (AE) and with usual care (UC). Our results showed that most outcomes improved over time and in health care costs reduced in the three groups. However, between group differences were small and we could not conclude about the effectiveness of the MD intervention. Program costs are not offset by subsequent savings in health care costs. Being employed and full participation in an intervention are independently associated with the patient’s global impression of improved health, whereas a longer duration of symptoms and higher perceived limitations in physical functioning contribute to a worse experience of health. Part II focuses on the role of the nurse in the care for patients with inflammatory arthritis. Based on evidence from a systematic review of the literature and expert opinions 10 European League Against Rheumatism (EULAR) recommendations for the role of the nurse in the management of inflammatory arthritis were formulated; seven recommendations cover the role of the nurse in care and management, whereas three recommendations focus on professional support for nurses. Subsequently, the recommendations were disseminated and evaluated. A web-based survey among nurses, rheumatologists and patients from 22 European countries and the USA showed a high level of agreement but a substantially lower level of application in daily practice. Agreement and application were lowest in Eastern- and Central Europe. Many reasons for disagreement with the recommendations and barriers to the application of the recommendations were reported that can be used to develop tailored strategies supporting further implementation of the recommendations for rheumatology nursing care.
    03/2014, Degree: PhD, Supervisor: Prof.dr.R. Landewé, Prof.dr. A. Boonen
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    ABSTRACT: Objective To compare the clinical safety of the rapid infusion of infliximab (30-45 min) with the traditional one (2 h). Patients and method Open, prospective study with the consecutive inclusion of 150 patients with rheumatoid arthritis (RA) and/or spondyloarthritis (AS), resistant to conventional treatment. Patients were randomly distributed to receive 1.5 or 3 mg/kg (according to medical criteria) into 2 groups of 75 patients. Group A: patients received a rapid infusion of infliximab (30-45 min) and group B: traditional intravenous infusion (2 h). The rhythm of infusion was regulated through drip counts and the rule of threes and time was counted on a digital chronometer. Data was obtained from all patients included on possible side effects, as well as efficacy parameters (visual analog scale for pain, tender, and swollen joint counts), and comparisons were made between the rapid infusion group and the traditional infusion group. Results All patients concluded the study without serious complications. In the rapid infusion group 3 patients had hypersensitivity in the infusion arm and erythema was present in 7 more. The presence of side effects was not significantly different in relation with the infusion speed. Differences were not found in relation to the dosage or the type of illness (RA and/or AS) either. The efficacy of Infliximab for symptom control showed no differences using both types of infusion. Conclusions The absence of noticeable secondary effects associated with the reduction in the time of infusion of infliximab permits us to point out that a reduction in the time of infusion of infliximab can be a method to optimize hospital resources concerning the outpatient clinic for biologic therapy.
    Reumatología Clínica 07/2007; 3(4). DOI:10.1016/S1699-258X(07)73616-1
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