The European Alliance of Associations for Rheumatology (EULAR) task force recently developed recommendations to improve the self-management skills of patients with inflammatory arthritis (IA). The article has been published in Annals of the Rheumatic Diseases.
Self-management of IA involves an understanding of the disease and an ability to manage its practical, physical, and psychologic aspects. By increasing patients’ self-management skills, health care providers (HCPs) can improve patient experiences, disease outcomes, and quality of life.
The objective of the EULAR task force was to develop recommendations for the implementation of self-management strategies in patients with IA, including rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis.
The EULAR commissioned a task force, which included 2 conveners, a methodologist, 2 fellows, 18 multidisciplinary experts, and patient representatives from 11 European countries. Prior to the first meeting, a scoping review was conducted to identify existing self-management resources for IA. The scope, definitions, overarching principles, clinically relevant questions, and best practices were discussed at this meeting. Based on these discussions, the taskforce fellows conducted a systematic literature review and surveyed patient organizations and HCPs across Europe. At the second meeting, the taskforce used the collected information to develop overarching principles and recommendations. In-person polling was conducted to determine a consensus, using a threshold of 75%. After the second meeting, 2 rounds of remote polling were conducted using a 0 to 10 level of agreement score. Recommendations with an agreement of 8 or more were included in the final recommendations. The level of evidence and strength were assigned to the final recommendations and a research agenda was developed based on unmet needs and evidence gaps.
Overall, 3 overarching principles and 9 recommendations were developed, which were centered on educating HCPs, strengthening collaborations, and providing patients with evidence-based information.
A. Patients should take an active role in understanding their condition and in the shared-decision process to manage their care.
B. There is a positive effect of self-efficacy (carrying out activities in a manner that aims to achieve a desired outcome) on the outcomes of patients with IA.
C. Patient organizations are an important self-management resource for patients. Involvement of HCPs in these organizations can be of great benefit to patients and is encouraged.
R1. HCPs should encourage patients to take an active role in their health care team and should connect patients to self-management resources provided by patient organizations and other trusted sources.
R2. Patient education is critical and should underpin all self-management interventions. HCPs should be aware of the EULAR recommendations for patient education and incorporate them into their clinical practice.
R3. There is strong evidence that problem solving, goal setting, and cognitive behavioral therapy are effective self-management strategies, and they should be encouraged by HCPs.
R4. HCPs should promote physical activity among patients as it has been shown to improve patient outcomes.
R5. Evidence-based lifestyle behaviors should be encouraged to better manage common comorbidities.
R6. A patient’s mental health impacts their ability to manage their condition and should be assessed regularly.
R7. The EULAR strives to increase participation in work by patients with IA. HCPs should address work-related aspects of IA and direct patients to resources and support to remain in the workforce.
R8. Digital resources and mobile health technologies should be included in self-management, where applicable.
R9. To optimize and support self-management, HCPs should be aware of available resources that might help their patients.
Focus Areas for Future Research
- Establishing the effectiveness of specific self-management strategies and their impact on disease activity.
- Identifying a core set of patient-reported outcomes (pain, fatigue, disability, quality of life, etc) potentially affected by self-management.
- Determining the cost-effectiveness of self-management interventions.
- Investigating the role of patient organizations and their impact on patients with IA.
- Comparing the impact of remote self-management interventions vs in-person interventions.
- Exploring how the EULAR can engage with less established patient organizations to adopt best practices to best serve their local communities
The task force concluded, “EULAR recommendations are now available for the implementation of self-management strategies in patients with IA. A dissemination strategy is currently underway to enhance the uptake of these recommendations, through national [organizations], patient [organizations] and educational [programs].”
Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Nikiphorou E, Santos EJF, Marques A, et al. 2021 EULAR Recommendations for the implementation of self-management strategies in patients with inflammatory arthritis. Ann Rheum Dis. Published online May 7, 2021. doi:10.1136/annrheumdis-2021-220249