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THU0706 Low disease activity after a short course of drug therapy and rehabilitation is associated to a greater improvement in functional capacity in rheumatoid arthritis
  1. B Cunha,
  2. B Ferreira,
  3. L Moreira,
  4. C Barros,
  5. A Gushikem,
  6. J Kauer,
  7. T Ferreira,
  8. on behalf of SARAR 2 cohort
  1. Rheumatology, SARAH Network of Rehabilitation Hospitals, Brasíia, Brazil

Abstract

Background Patients with rheumatoid arthritis (RA) have lower funcional capacity than general population (1). Studies have shown that patients are able to improve their functional capacity after adequate treatment with disease-modifying antirheumatic drugs (DMARDs) (1–2), but it is unclear which other factors are involved in rehabilitation settings.

Objectives To investigate which clinical factors are associated to improvement in funcional capacity in patients with RA in the context of DMARD therapy and rehabilitation.

Methods It was a case-control study. Patients with RA admitted between june 2014 and july 2016 were included. Assessments were carried out just before and after completion of rehabilitation program. Functional capacity was assessed with Health Assessment Questionnaire-Disability Index (HAQ-DI). Disease activity was evaluated with Clinical Disease Activity Index (CDAI). It was allowed to change DMARD treatment or dose during the follow-up period. Interventions were carried out at the discretion of the rehabilitation team and could include joint injections, exercises, orthoses, insoles, educational interventions and assistive devices. Patients that were operated in the follow-up period were excluded.

An improvement in HAQ-DI was defined as a difference of -0,22. Patients that improved after treatment were compared with those who did not, regarding clinical caracteristics and modalities of treatment that were employed. Chi-square or Fisher exact test analyses were employed.

Results Forty-six women and two men were included, with average age of 56 (11) years old and 10,8 years of diagnosis, Rheumatoid factor was positive in 58% (mean title 242,3 U/L); anti-CCP was positive in 48% (mean title 283,8 U/L). Patients were followed for 6–12 months.

HAQ-DI improved 0,51 (0,3–0,71; p<0,001) and CDAI improved 12,8 (7,6–17,9). Patients who were able to improve HAQ-DI had a better average CDAI in the second assessment (16 vs. 7, p=0,011). There was no association between improvement of HAQ-DI and other clinical and laboratorial variables, including drug and rehabilitation modalities.

Conclusions Low disease activity after a short course of drug therapy and rehabilitation is related to a greater improvement of functional capacity in patients with RA. Therefore, patients with RA may have better outcomes in rehabilitation if disease activity is controlled.

References

  1. Mota LM, Laurindo IM, dos Santos Neto LL. Prospective evaluation of thequality of life in a cohort of patients with early rheumatoid arthritis. Rev BrasReumatol. 2010 May-Jun;50(3):249–61.

  2. Norton S, Fu B, Scott DL, Deighton C, Symmons DP, Wailoo AJ, Tosh J, Lunt M. Davies R, Young A, Verstappen SM. Health Assessment Questionnaire disabilityprogression in early rheumatoid arthritis: systematic review and analysis of two inception cohorts. Semin Arthritis Rheum. 2014 Oct;44(2):131–44.

References

Disclosure of Interest None declared

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