{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T10:03:05Z","timestamp":1790762585562,"version":"4.1.0"},"reference-count":20,"publisher":"PAGEPress Publications","issue":"3","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reumatismo"],"abstract":"<jats:p>Objective. To investigate the role of family and community health nurses (FCHNs) in monitoring the safety and efficacy of biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) in chronic rheumatic diseases.\nMethods. We followed 141 consecutive patients (median age 59 years; 69% female) with autoimmune diseases, mainly rheumatoid arthritis (RA; 46.1%) and spondyloarthritis (SpA; 46.8%), receiving bDMARDs or tsDMARDs from January 2024 to March 2025 (\u201cIFER\u201d protocol). FCHNs monitored treatment safety and efficacy using patient-reported outcomes every 2 months and composite disease activity indices at 6 and 12 months. Patients with adverse events, disease complications, or high disease activity were referred to the rheumatologist for treatment reassessment. Major adverse events, healthcare costs, and rheumatology visits were compared with historical data from 2021 to 2023.\nResults. No significant difference in major adverse events was observed compared with previous years (deaths: 2 vs. 3; hospitalizations: 9 vs. 25; emergency room visits: 3 vs. 12; p=ns). Agreement between rheumatologists and FCHNs in disease activity assessment was moderate overall (Cohen\u2019s \u03ba=0.54\u00b10.06), good in RA (\u03ba=0.65\u00b10.08), and poor in SpA (\u03ba=0.29\u00b10.10). Per-capita annual costs decreased significantly (\u20ac5164 vs. \u20ac4590; p&lt;0.001), as did rheumatology visits per patient\/year (2.16 vs. 1.67; p&lt;0.001). First-line treatment significantly increased during the IFER period (Log-rank p&lt;0.001).\nConclusions. FCHN-led monitoring of patients receiving bDMARDs or tsDMARDs appears feasible, safe, and cost-effective. Further studies are warranted to confirm these findings.<\/jats:p>","DOI":"10.4081\/reumatismo.2026.1925","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:20:07Z","timestamp":1788877207000},"source":"Crossref","is-referenced-by-count":0,"title":["The convenience of family and community health nurses-led care for the treatment of rheumatic diseases with biological or targeted synthetic disease-modifying antirheumatic drugs. The experience of Valcamonica, Italy"],"prefix":"10.4081","volume":"78","author":[{"given":"Ambra","family":"Mosconi","sequence":"first","affiliation":[{"name":"Territory District, ASST of Valcamonica, Breno (BS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomina","family":"Macri","sequence":"additional","affiliation":[{"name":"Territory District, ASST of Valcamonica, Breno (BS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Pelamatti","sequence":"additional","affiliation":[{"name":"Hospital Pharmacia, ASST of Valcamonica, Esine (BS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flora","family":"Inverardi","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medical Sciences, ASST of Valcamonica, Edolo (BS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renza","family":"Richini","sequence":"additional","affiliation":[{"name":"Hospital Pharmacia, ASST of Valcamonica, Esine (BS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Laura","family":"Ghirardelli","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Medical Sciences, ASST of Valcamonica, Esine (BS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Furloni","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Medical Sciences, ASST of Valcamonica, Esine (BS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto Domenico","family":"Strazzeri","sequence":"additional","affiliation":[{"name":"Medicine Unit of Edolo, Department of Medical Sciences, ASST of Valcamonica, Edolo (BS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmela Stefania","family":"Rizzi","sequence":"additional","affiliation":[{"name":"Medicine Unit of Edolo, Department of Medical Sciences, ASST of Valcamonica, Edolo (BS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Galbassini","sequence":"additional","affiliation":[{"name":"Medicine Unit of Edolo, Department of Medical Sciences, ASST of Valcamonica, Edolo (BS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Laffranchini","sequence":"additional","affiliation":[{"name":"Territory District, ASST of Valcamonica, Breno (BS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Cincera","sequence":"additional","affiliation":[{"name":"Territory District, ASST of Valcamonica, Breno (BS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Air\u00f2","sequence":"additional","affiliation":[{"name":"Rheumatology and Clinical Immunology Unit, Spedali Civili and University of Brescia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Franceschini","sequence":"additional","affiliation":[{"name":"Rheumatology and Clinical Immunology Unit, Spedali Civili and University of Brescia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirko","family":"Scarsi","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medical Sciences, ASST of Valcamonica, Edolo (BS)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"17697","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.123919"},{"key":"17698","unstructured":"Ministry of Health. DM 77, 23\/05\/2022. Regolamento recante la definizione di modelli e standard per lo sviluppo dell\u2019assistenza territoriale nel Servizio Sanitario Nazionale (22G00085). In GU Serie Generale n. 144, 22\/06\/2022."},{"key":"17699","unstructured":"DGR 6760, 25\/07\/2022. Ulteriori determinazioni in merito alle Centrali Operative Territoriali e in merito alla garanzia di assistenza medica H24 nelle Casi di Comunit\u00e0 in raccordo con il sistema della Continuit\u00e0 Assistenziale."},{"key":"17700","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-198601000-00007"},{"key":"17701","doi-asserted-by":"publisher","DOI":"10.1037\/t02366-000"},{"key":"17702","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-215458"},{"key":"17703","doi-asserted-by":"publisher","DOI":"10.1111\/jan.12183"},{"key":"17704","doi-asserted-by":"publisher","DOI":"10.1002\/2327-6924.12525"},{"key":"17705","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-015-0817-6"},{"key":"17706","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32158-5"},{"key":"17707","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24625"},{"key":"17708","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2017.03.014"},{"key":"17709","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjms.2022.06.021"},{"key":"17710","doi-asserted-by":"publisher","DOI":"10.1016\/j.ard.2025.03.003"},{"key":"17711","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-215882"},{"key":"17712","doi-asserted-by":"publisher","DOI":"10.1002\/acr.25045"},{"key":"17713","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-025-05870-y"},{"key":"17714","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14113624"},{"key":"17715","doi-asserted-by":"publisher","DOI":"10.1111\/1756-185X.70234"},{"key":"17716","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/27.5.357"}],"container-title":["Reumatismo"],"original-title":[],"link":[{"URL":"https:\/\/www.reumatismo.org\/reuma\/article\/download\/1925\/1122","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.reumatismo.org\/reuma\/article\/download\/1925\/1122","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T09:28:34Z","timestamp":1790760514000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.reumatismo.org\/reuma\/article\/view\/1925"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":20,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9,30]]}},"URL":"https:\/\/doi.org\/10.4081\/reumatismo.2026.1925","relation":{},"ISSN":["2240-2683","0048-7449"],"issn-type":[{"value":"2240-2683","type":"electronic"},{"value":"0048-7449","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9,8]]}}}