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A Patient-Centered Approach: The Emerging Role of Rheumatology Nursing

January 2014

When Victoria Ruffing, RN, CCRN, first started working at the Johns Hopkins Arthritis Center in Baltimore, Md., biologics had just become available to treat arthritis patients. In the past 14 years, she has seen rheumatology nursing continue to evolve as new treatment options have emerged and new discoveries have been made about the immune system and rheumatic disease.

“In rheumatology, there is always something new to learn,” said Ruffing, who has been a member of the Johns Hopkins Arthritis Center since 2000 and currently serves as the Nurse Manager. “It’s one discipline of nursing that is continually changing. It’s almost like a brand new field of medicine.”

When biologics first came onto the market, there were suddenly additional options for rheumatic disease patients who didn’t respond to standard treatments. The new medications gave many patients hope, but were often complicated to understand.

“Nurses play a key role in helping rheumatology patients make informed treatment decisions,” said Ruffing. “Rheumatic diseases are not like a broken leg – they are very complicated diseases, and treatment options have multi-faceted effects on the disease and the patient’s immune system. As a rheumatology nurse, I seek to educate patients about their disease state, and help empower them to find the best treatment option.”

According to Ruffing, the approach to treating patients with rheumatoid arthritis (RA) has moved towards “treat to target,” also known as tight control method. Treat to target, already prevalent in diabetes care, was first applied to RA in Europe, and has recently gained popularity in the United States.

“With treat to target, a goal is set for each patient – either full remission or the lowest possible disease activity. In order to achieve that goal, the healthcare team must track a patient’s condition each time they come into the clinic,” said Ruffing. “Nurses take the lead in managing the measurement of a patient's symptoms, whether examining each joint to see if there is swelling or tenderness, or completing questionnaires with the patient to monitor their levels of fatigue, pain and flare ups.”

As nurses continue to play a bigger role in rheumatology care, the importance of the nurse-patient relationship is even more evident.

“Rheumatology nurses develop unique, long-term relationships with their patients,” said Ruffing. “I know my patients so well that when they walk in the door, I immediately know how they’re feeling, and I can tell if there’s been some change or a flare-up. In fact, I’ve had many of the same patients since I started working at the clinic.”

According to Ruffing, rheumatology nurses are similar to oncology nurses and diabetic nurse educators, as they help patients take an active role in managing their disease.

“Nursing’s traditional focus on patient-centered outcomes is especially relevant for rheumatic disease patients,” said Ruffing. “Nurses innately know how to treat the patient, not only the disease, and we measure how a patient feels and functions. The patient-centered approach is critical for the future of rheumatology.”

Ruffing remains hopeful that new treatments and technology will continue to improve her patients’ lives. “Nurses can help patients understand that they don’t have to accept feeling just ‘ok’ with a rheumatic disease. We want patients to be able to speak up and say ‘I think I can feel better than this. I want to feel better than this. And I can.’”

For more information about rheumatology nursing, visit

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