Comparing Primary Care Providers Trained in Rheumatoid Arthritis Management to Rheumatologist Care in a Randomized Study

What this Trial Is About

Rheumatoid arthritis RA is a chronic autoimmune disease where the immune system attacks joint tissue, causing pain, swelling, and stiffness. This condition affects about 1.5 million people in the US and can lead to serious joint damage if untreated. Access to specialized rheumatology care is limited, especially in rural areas like northern New York, making it difficult for many patients to receive proper treatment. This trial evaluates whether trained primary care providers PCPs can manage stable RA patients as effectively as rheumatologists, potentially improving care access in underserved regions. In this randomized controlled trial, patients with stable RA will be assigned to either continue care with their usual rheumatologist or receive care from a PCP who has completed a structured RA training program. Nine PCPs underwent training including lectures, case studies, and exams, with ongoing monthly case reviews with rheumatology specialists. The study will enroll up to 100 participants and follow them for one year, comparing the two care models. The intervention group receives RA management from trained PCPs, while the control group continues usual care in a rheumatology clinic. Participants will attend visits at screeningbaseline, 6 weeks, 12 weeks, 26 weeks, 40 weeks, and 52 weeks. Assessments include standard RA activity measures like MDHAQ, joint counts, disease activity scores DAS28, CDAI, SDAI, glucocorticoid exposure, patient-reported outcomes, and medical records review. The main outcome is change in DAS-28 at 6 and 12 months. This study will monitor patient status and safety throughout the year to evaluate if PCP-led care can maintain disease control and improve access for rural RA patients.

Comparative Effectiveness of Primary Care Providers Trained in Rheumatoid Arthritis Management Versus Rheumatologist Care: A Randomized Controlled Trial