This study reviewed the effect of biological agents on participation in paid work among patients with rheumatoid arthritis (RA). A systematic literature search was performed to identify published articles reporting the effect of biological agents on employment status, sick leave and/or presenteeism. The quality of included articles was assessed according to the guidelines as proposed by the Dutch Cochrane Centre. Narrative summaries were used to present the data separately for randomised controlled trials (RCTs) as well as controlled and uncontrolled cohort studies. 19 studies (six uncontrolled cohorts, seven controlled cohorts and six RCTs) were included, in which 11 259 patients were treated with biological agents. Employment status improved in four out of 13 studies, absence from work in all 10 studies and presenteeism in seven out of nine studies that reported this outcome. For absenteeism and presenteeism the statistical significance of change or difference was not always provided and results within studies were sometimes conflicting when using different time frames or alternative outcomes. The large heterogeneity in terms of population, design, analyses and most important in outcome measures limits interpretation of the data. RCTs as well as cohort studies showed positive results of biological agents on both absenteeism and presenteeism compared with other disease-modifying antirheumatic drugs (DMARD), continuing the failing DMARD, the general population or the situation before the start of biological agents. The effect on employment status was more conflicting, but 50% of studies that addressed patients with early methotrexate-naive RA showed a positive result on employment status.
The purpose of this study was to assess the effectiveness of Stanger bath on the treatment of fibromyalgia (FM). Fifty women with FM were randomly divided into two groups. The first group (n=25) was treated with amitriptyline, 10 mg/day for 8 weeks, and Stanger bath, 20 min daily for ten sessions. The second group (n=25) only had amitriptyline, 10 mg/day for 8 weeks. In the first group the assessment parameters were measured before (t1), at the end (t2), and 2 months after the hydrotherapy (t3). In the second group these parameters were examined before (T1) and 2 months after the treatment (T2). Patients were evaluated by number of tender points and Fibromyalgia Impact Questionnaire (FIQ) scores. There was significant improvement in number of tender points between t1 and t2 (P<0.01) and t1 and t3 (P<0.001) in the Stanger bath group. In addition, there was significant improvement in FIQ scores between t1 and t2 (P<0.001) and t1 and t3 (P<0.01) in the Stanger bath group. In the second group we observed significant improvement in FIQ scores and tender point numbers between T1 and T2 (P=0.00). We did not find any difference between groups in tender point number percent change (p=0.074). However, we observed statistically significant improvement in percent change of FIQ scores in Stanger bath group (-30+/-16.7) when compared to group 2 (-19.3+/-13) (p=0.016). We conclude that Stanger bath therapy when combined with amitriptyline has a long lasting effect and better outcome in FM patients.
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