Background Impairment of range of motion and muscle strength, work disability, loss of social participation result in reduction of health-related quality of life in patients with rheumatoid arthritis (RA). Rehabilitation techniques help to manage the disease in addition to medical treatment [1–3].
Objectives To evaluate the efficacy of 6-months complex rehabilitation program in patients with early RA receiving adalimumab.
Methods 33 patients with early RA (87,9% females, age of 18 to 62 years, disease duration of 4 to 16 months) were included and randomized into 2 groups. All patients received adalimumab subcutaneously 40 mg once every 2 weeks and methotrexate 15-25 mg per week. 16 study group patients underwent 6-months complex rehabilitation program: hospital stage (2 weeks): local air cryotherapy (–60°C, Criojet Air C600) for hand, knee or ankle joints for 15 min, 45-min therapeutic exercises under the supervision of a trainer, 45-min occupational therapy (joint protection strategies, use of assistive devices and adaptive equipment for personal care, mobility and household, adaptations for housing), 10 sessions, orthoses (functional wrist and knee orthoses, individual orthopedic insoles), education program (4 daily 90-min studies) and outpatient stage (6 months): 45-min home-based exercises 3 times a week, orthoses. 17 patients received only drug therapy (control). Tender and swollen joint count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), joint pain on 100-mm VAS, DAS28, HAQ, RAPID3, hand grip strength, the average powers of knee extension and ankle flexion by EN-TreeM movement analysis were evaluated at baseline and at 6 months.
Results After 6 month in the study group tender joint count decreased by 74,8% (p<0,01), swollen joint count – by 76,2% (p<0,01), ESR – by 64,6% (p<0,01), CRP – by 61,3% (p<0,01), joint pain - by 75,7% (p<0,01), DAS28 – by 33,5% (ΔDAS28=1,39±0,31, p<0,05), HAQ – by 76,8% (ΔHAQ=0,98±0,56, p<0,01), RAPID3 – by 62,4% (ΔRAPID3=5,99±0,85, p<0,01). The grip strength of a more affected hand enhanced by 46,2% (p<0,05), of a less affected – by 34,1% (p<0,05). The average extension power of a weaker knee increased by 89,5% (p<0,01), of a stronger – by 72,3% (p<0,01). The average flexion power of a more affected ankle joint elevated by 82,7% (p<0,01), of a less affected – by 70,9% (p<0,01). After 6 months, in the study group there were statistically significant differences from the control group in the most parameters (p<0,05), excluding the indicators of inflammatory diseases activity: swollen joint count, ESR, CRP, DAS28 (p>0,05). After 6-months in the study group there was significantly more frequently a good response to treatment according to the EULAR criteria (DAS28) (81,3% vs 58,8% in the control group, p<0,05).
Conclusions 6-month complex rehabilitation program increases functional ability and motion activity, relieves pain, helps to control disease activity and improves quality of life in patients with early RA receiving adalimumab.
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Disclosure of Interest None declared
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