# Nurses’ Role in Patient Education for Managing Inflammatory Joint Diseases: Insights from a Cross-Sectional Survey in Bulgarian Rheumatology Clinics

## TL;DR

This study explores how patients with inflammatory joint diseases in Bulgaria rate the educational support provided by nurses and finds that nurse-led education is highly valued, though some patient groups are less satisfied.

## Contribution

The study provides new insights into patient perceptions of nurse-led education in managing inflammatory joint diseases in Bulgaria, highlighting diagnostic and social status differences.

## Key findings

- Patients generally rated nurse-led education highly for treatment, self-injection skills, lifestyle, and psychological well-being.
- AxSpA patients reported lower satisfaction compared to RA and PsA patients.
- Working patients and retirees with disability gave the lowest ratings in RA and PsA groups.

## Abstract

Background: Nurses play a central role in the management of inflammatory joint diseases (IJD), of which the success depends on patient adherence to treatment, self-monitoring, timely detection of adverse drug reactions (ADRs), and adopting a healthy lifestyle. This study sought to examine the opinions of patients with IJD regarding the educational and supportive contributions of nurses. Methods: The research is based on a cross-sectional survey of patients with IJD treated with biologic disease-modifying antirheumatic drugs (bDMARDs) in two rheumatology clinics in Plovdiv, Bulgaria, from the beginning of August 2024 to the end of January 2025. The group included patients of three diagnoses: (1) rheumatoid arthritis (RA), (2) psoriatic arthritis (PsA), and (3) axial spondyloarthritis (axSpA). Results: Regardless of the diagnosis, and after adjusting for covariates, patients rated the roles of nurses in disease treatment and management, the acquisition of self-injection skills for bDMARDs, the implementation of a healthy lifestyle, and the maintenance of psychological well-being at the higher end of the 0 to 4 scale. However, the axSpA patients were less affirmative in their responses compared to the RA and PsA patients. In the RA and PsA groups, the working patients were associated with the lowest ratings, followed by retirees with disability. Conclusions: Our findings indicate that nurse-led education in patient self-management skills is greatly appreciated by patients with IJD. Further developments in specialized training programs tailored to the specific needs of different diagnoses and in consideration of patients’ social status will lead to increased patient satisfaction and a better overall quality of life.