Background Rheumatoid arthritis (RA) impairs patient function and quality of life (QoL) which, in turn, may lead to invalidity and chronicity of pain1. Even though a variety of effective treatments are available, there is still a significant portion of patients not attaining remission, of whom many continue to report moderate to high pain and fatigue despite low levels of inflammation1. Interdisciplinary interventions are promising approaches that may complement the medication effect on patient well-being and disease control, however previous studies on the effectiveness of interdisciplinary interventions seem conflicting.
Objectives The primary objective is to compare the DAS28 response between patients receiving an interdisciplinary intervention (Intervention group) and patients followed under standard rheumatologic practice (Control group). Secondary objectives are to compare patient-reported outcomes such as pain, fatigue, general health, and patient empowerment between the two groups.
Methods Prospective quasi-experimental, matched cohort (age, gender) study. Adult patients with a diagnosis of RA and DAS28 (CRP)>2.6 are eligible for the study. The Intervention group (n=28) benefits from interdisciplinary team intervention with the following professionals: rheumatologist, nurse, physiotherapist, social worker, kinesiologist, occupational therapist, and nutritionist. The Control group (n=32) receives a conventional rheumatologist-nurse intervention. Both groups see the rheumatologist approximately three times over 12 months. Interdisciplinary meetings take place in the hospital setting with the patients at Month 0 and Month 12 and without them at Month 6. The following outcome measures are used at each visit to the rheumatologist: patient pain, fatigue (Multidimensional Assessment of Fatigue; MAF), disability (HAQ), quality of life (SF-36), patient empowerment (Patient Activation Measure; PAM13), and patient satisfaction (QSC-F; only in Intervention group at Month 12).
Results A total of 28 patients were enrolled in the Intervention group and 32 in the Control group without any significant differences in demographics or disease parameters with the exception of disease duration which was significantly higher in the Intervention group (10.9 vs. 5.8 years; p=0.021). Within 6 months of treatment, clinically important and statistically significant (p<0.01) improvements in DAS28 were observed in both groups which were maintained until 12 months. Overall, at 12 months, DAS28 response was comparable between groups (68% vs. 63%; p=0.140). However, when looking at patients with established RA (75% vs. 66.7%; p=0.039) and patients with low to moderate disease activity at baseline (73.9% vs. 56.5%; p=0.035), a higher response rate was observed in the Intervention group. No statistical differences were observed in the remaining outcomes between groups.
Conclusions The results of the current study suggest that interdisciplinary interventions may be useful in conferring benefits on patient well-being and disease control that are above and beyond those resulting from medications. This seems to be particularly true among patients with established disease. Additional analyses looking into the exact mechanism of action of such interventions are required.
Disclosure of Interest I. Fortin Grant/research support from: grant UCB, H. Sylvain Grant/research support from: Grant UCB, F. Banville Grant/research support from: UCB, B. Lovisi: None declared, S. V. Rochefort Grant/research support from: UCB
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