19. Treatment guidelines for polymyalgia rheumatica: the nursing perspective

Résumé fourni par la source

The impact of developing PMR is immense for the patient and from a nursing perspective requires a holistic approach to care. Education at diagnosis is crucial. This includes education about the disease itself, medications required and the potential impact of the condition on the person as a whole. It is important for the patient to be given time at the first appointment to absorb the facts and be able to ask questions. Taking the time to explain the reasons for the glucocorticoid (GC) treatment, the benefits of the medication and the potential side effects will allow the patient to participate in the process of shared decision making and lead to patient empowerment. Reinforcement of education: The primary focus of a nursing collaboration is to reinforce and clarify the information given to them by the doctor. Including the patient in the nursing or medical consultation, explaining blood tests results and what they mean in relation to activity of the condition will allow the patient to gain an understanding of the decision process related to steroid therapy, dosing and treatment goals. Discussing glucocorticoids: With the patient and the reasons for altering the dose in relation to symptoms will enhance patient knowledge of their own condition, build up self-confidence in the patient’s own ability to understand the differences between activity of the disease compared with other symptoms such as mechanical pain. As with the DAS score for RA, it will be beneficial to develop an assessment tool that assesses disease activity of PMR at each appointment. Physiotherapy: Alongside information provided in the clinic setting, early referral to the physiotherapist is important. An initial physiotherapy assessment followed by an individualized exercise programme to maintain muscle strength in the upper and lower limbs will be beneficial alongside medical treatment. Other co-morbidities such as OA can be addressed at the same time enabling the patient to distinguish between their OA and symptoms of PMR. Advice line: An initial diagnosis of PMR and a prescribing a treatment regime is daunting to many people. Therefore a rheumatology advice line for PMR is important. An experienced clinical nurse specialist is able to discuss the symptoms, view recent blood test results, clinic correspondence and work through patient concerns and adverse events, and come to a treatment plan which may or may not require follow-up consultation with the doctor. This allows the patient query to be resolved either over the telephone, an urgent rheumatology appointment or by advising the patient to see the general practitioner if the problem is unrelated to PMR. Providing an advice line for patients may prevent unnecessary increases in the GC and may also prevent additional general practitioner visits. Participation in research: The nurse specialist may also be able to motivate patients to join research studies and clinical trials that are urgently required for understanding and treatment of the condition.

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