Background Rehabilitation techniques, including physical exercises, physiotherapy, occupational therapy, patient education, give the patients with rheumatoid arthritis (RA) the strategies necessary to manage their disease in addition to drug treatment [1–4].
Objectives To evaluate the efficacy of 12-month complex rehabilitation program in patients with RA receiving biologic DMARDs.
Methods 64 patients with RA (87,5% females, age of 19 to 62 years, disease duration of 9 months to 10 years) were included and randomized into 2 groups. All patients received biologic DMARDs (adalimumab subcutaneously 40 mg once every 2 weeks or etanercept subcutaneously 50 mg per week or abatacept intravenously 750 mg once every 4 weeks) with methotrexate 20–25 mg per week. 34 study group patients underwent 12-month complex rehabilitation program: 15-min local air cryotherapy (−60°C, Criojet Air C600) for joints, 2 courses for 10 sessions with a mean interval of 6,4 months; 45-min therapeutic exercises 3 times a week, at first under the supervision of a trainer, further own at home; 45-min occupational therapy (joint protection strategies, use of assistive devices and adaptive equipment), 10 sessions; wrist and knee orthoses, orthopedic insoles; education program (4 daily 90-min studies). 30 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 12 months.
Results 27 patients finished 12-month rehabilitation program. 7 patients did not complete the study, because they had a low compliance to home-based exercises. After 12 months in the study group tender joint count decreased by 83,7% (p<0,01), swollen joint count – by 81,6% (p<0,01), ESR – by 72,3% (p<0,01), CRP – by 68,3% (p<0,01), pain on VAS – by 80,4% (p<0,01), DAS28 – by 44,7% (ΔDAS28=2,25±0,79, p<0,05), HAQ – by 73,8% (ΔHAQ=1,39±0,56, p<0,01), RAPID3 – by 65,1% (ΔRAPID3=6,23±1,73, p<0,01). The grip strength of a more affected hand enhanced by 48,6% (p<0,01), of a less affected – by 36,5% (p<0,05). The average extension power of a weaker knee increased by 87,3% (p<0,01), of a stronger – by 70,5% (p<0,01). The average flexion power of a more affected ankle joint elevated by 79,3% (p<0,01), of a less affected – by 74,7% (p<0,01). In the study group there were statistically significant differences from the control group in the most parameters (p<0,05), excluding CRP and DAS28 (p>0,05). After 12 months in the study group there was significantly more frequently a good response to treatment according to the EULAR criteria (DAS28) (92,6% vs 70,0% in the control group, p<0,05).
Conclusions 12-month complex rehabilitation improves functional ability, motion activity and quality of life, relieves pain and helps to control disease activity in biologic DMARD-treated RA patients.
Forestier R, et al. Joint Bone Spine 2009;76(6):691–8.
Hurkmans EJ, et al. Acta Reumatol Port 2011;36(2):146–58.
Vliet Vlieland TPM. Best Pract Res Clin Rheumatol 2009;23(1):103–16.
Vliet Vlieland TPM, van den Ende CH. Curr Opin Rheumatol 2011;23(3):259–64.
Disclosure of Interest None declared