For clinicians

Nurse-led reproductive rheumatology

nurse-led clinic, clinical nurse specialist, nurse navigator

Looking for the plain-language version? See the patient version of this page.

Bottom lineNurse-led multidisciplinary clinics are a well-established international model for reproductive rheumatology. They improve counselling, medication adherence, breastfeeding rates, and continuity. Presented here as a legitimate counterpart to extended-role and advanced-practice-provider models, not in competition with them.

The model in practice

What a nurse-led clinic does ●●○○low evidenceconditional

Specialist nurses provide structured counselling, medication education, monitoring, and care coordination within a rheumatology and obstetric-medicine team.^{[1, 2]}

What the evidence shows ●●○○low evidenceconditional

The Rotterdam PreCARA experience shows that active counselling with controlled disease improves breastfeeding rates and adherence, with high patient-reported satisfaction. A recognised gap even in highly rated nurse-led clinics is under-served mental-health support. The PreCARA time-to-pregnancy analysis (Quaak 2026) attributes part of its fertility effect to the counselling pathway itself: structured advice on cycle, lifestyle, sexuality and medication, plus gynaecology referral, none of which the historical comparator received. The authors name it a limitation of their treatment claim, which makes it direct evidence for the coordinating role rather than for any single drug.^{[1, 3]}

Across the pregnancy journey ●●○○low evidenceconditional

Coordination spans pre-conception, antenatal monitoring, delivery planning, and the postpartum and lactation phase, including flagging the postpartum mental-health needs that are often under-addressed.^{[1, 2]}

One model among several ●●○○low evidenceconditional

Nurse-led, extended-role-practitioner (for example ACPAC), nurse-practitioner, physician-associate, and clinical-nurse-specialist models are all legitimate. The coordinating function matters more than the specific credential; the best fit depends on workforce, regulation, and funding.^[2]

Key points

Point	Evidence
A dedicated coordinating role is the shared, high-value feature across all advanced-practice reproductive rheumatology models.^{[1, 2]}	●●○○low evidenceconditional

References

Kemper MJ, Ghalandari N, Wintjes HM, et al. Active counselling and well-controlled disease result in a higher percentage of women with rheumatoid arthritis that breast feed: results from the PreCARA study. RMD Open. 2022;8(2):e002194. doi:10.1136/rmdopen-2022-002194 https://doi.org/10.1136/rmdopen-2022-002194
El Miedany Y, Palmer D. Rheumatology-led pregnancy clinic: enhancing the care of women with rheumatic diseases during pregnancy. Clin Rheumatol. 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC7648739/
Quaak CH, Roder E, Wintjes HM, van Steensel-Boon AJ, Mulders AGMGJ, Kranenburg-van Koppen LJC, Dolhain RJEM. Time to pregnancy in women with rheumatoid arthritis who want to conceive treated according to a treat-to-target approach: a comparison of an observational cohort with a historical reference cohort. Lancet Rheumatol. 2026;8(6):e461-e469. doi:10.1016/S2665-9913(26)00001-9 https://doi.org/10.1016/S2665-9913(26)00001-9