January 2016 Newsline published ahead of print.

Patients with rheumatoid arthritis (RA) fare better in practices staffed with nurse practitioners (NPs) or physician assistants (PAs), according to research published in Arthritis Care & Research.

Daniel H. Solomon, MD, MPH, a physician at Brigham and Women’s Hospital in Boston and a professor at Harvard Medical School, and colleagues enrolled 7 rheumatology practices across the United States—4 practices with NPs or PAs and 3 practices without. Medical records of 301 patients were reviewed, representing 1,982 total visits; 77% of patients were female, and the mean age was 61 years.

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“The Affordable Care Act proposes wider use of NPs and PAs,” said Dr. Solomon, “but little is known about outcomes of care provided by them in medical specialties.”

When researchers compared care outcomes across both types of practices, primary analysis indicated that patients receiving care in practices with NPs or PAs were more likely to have lower disease activity (odds ratio 0.32) than patients receiving care in rheumatologist-only practices. 

“Patients seen in practices with NPs or PAs had lower RA disease activity over 2 years, compared to those seen in rheumatologist-only practices,” Dr Solomon concluded. “No differences were observed in the change in disease activity between visits either within or between the different types of provider practice.”


  1. Solomon DH, Fraenkel L, Lu B, et al. Comparison of care provided in practices with nurse practitioners and physician assistants versus subspecialist physicians only: a cohort study of rheumatoid arthritis. Arthrit Care Res. 2015; doi: 10.1002/acr.22643