A Randomized Trial of Three Psychosocial Treatments for the Symptoms of Rheumatoid Arthritis

Abstract

Objective-To assess and compare the benefits of three psychosocial treatments for rheumatoid arthritis.Methods-Rheumatoid arthritis (RA) patients were randomized to cognitive-behavior therapy (CBT), relaxation response training (RR), or arthritis education (AE). All treatment was conducted in groups. Follow-up occurred immediately after treatment and 6 and 12 months later. Pain, other RA symptoms, role impairment, and psychological distress were assessed with standardized selfreport questionnaires. Arthritis severity and activity were assessed with a joint examination, erythrocyte sedimentation rate, grip strength, and walking time. An intent-to-treat analytic strategy was employed. Linear regression was used to establish treatment effect on pain and other RA symptoms, while adjusting for sociodemographic and clinical variables.Results-168 patients were randomized. Pain improved significantly at 12 months in the RR and AE groups and showed a non-significant positive trend with CBT. Other RA symptoms improved significantly with CBT and AE, and showed a non-significant trend with RR. There were no significant differences in the outcomes across the 3 treatment groups. When the results for all 3 groups were aggregated, significant benefits were found for pain, other RA symptoms, self-care activities and social activities. Effect sizes ranged between 0.26 and 0.35.Conclusions-These three psychosocial treatments were beneficial, with treatment effect sizes in the small to moderate range. The effects appeared immediately after treatment and were generally sustained at long-term follow-up. These benefits were achieved over and above those

Investigating the short-term impact of cognitive-behavioral therapy (CBT) on quality of life in Persian patients with rheumatoid arthritis: the heterogeneous impact on Arthritis Impact Measurement Scales (AIMS-2)

“…This result opposes those of a number of previous studies [14,17,20,21]. Moreover, no improvement in social activity was observed after CBT, which was in contrast to past studies [17, 22,23].…”

Étude contrôlée du rôle d’une éducation thérapeutique personnalisée pour les patients suivis pour une polyarthrite rhumatoïde

“…D'autres évaluent la satisfaction globale des patients, la capacité d'autosoins [31][32][33] avec des résultats globalement positifs. Enfin, certaines études comparent des méthodes d'éducation thérapeutiques entre elles [34][35][36][37][38][39][40][41][42]. Nous avons analysé et retenu les 18 études de la littérature ayant évalué l'ETP dans la PR comparativement à un groupe contrôle (Tableau 5) [18][19][20][21][22][24][25][26][27][28][29][30][31][32][33][43][44][45][46][47].…”

“…Elles sont extrême-ment hétérogènes. Deux études ont opté pour un simple livret d'information comme groupe témoin [24,46] et 2 études ont associé des rhumatismes psoriasiques et des arthroses [33][34][35][36][37][38][39][40][41][42][43][44][45][46]. L'ETP avait pour but le plus souvent de susciter des aptitudes à l'autosoin [32][33][34]43], mais parfois l'éducation portait sur des aspects spécifiques (facteurs de risque cardiovasculaires [23], pharmacologie [19], ergothérapie [22], exercice [20,21]).…”

My Treatment Approach to Rheumatoid Arthritis

“…Education of patients about the pathophysiologic characteristics of the disease, self-management skills, and principles of joint protection lead to improved health and physical function. 49,50 Occupational therapy, in particular, is beneficial for instruction about joint protection and prescription of assistive devices, orthotics, and splints, which can substantially improve function and reduce pain. [51][52][53] We advise patients that adequate rest reduces fatigue associated with active rheumatoid arthritis and that resting joints during periods of poorly controlled inflammation will lessen the symptoms of the disease.…”