Comprehensive rehabilitation of patients with early rheumatoid arthritis: results of 6-month program

Abstract

Objective: to evaluate the efficiency of a comprehensive rehabilitation program (CRP) in patients with early rheumatoid arthritis (RA) for 6 months. Subjects and methods. Sixty patients with early RA were examined. During medical therapy, 6-month CRP was implemented in 34 patients in the study group. The 2-week in-hospital stage involved ten sessions of 15-min local air cryotherapy (-60 °C) of the hands, knee or ankle joints; ten classes of 45-min therapeutic exercises (TE) under the supervision of a trainer; ten sessions of 45-min ergotherapy (training people how to therapeutically position their joints, to apply their protective methods, to lift and move things, to use assistive devices, and to do hand exercises); orthotics (working wrist orthoses, knee ones, or individual orthopedic insoles); and four 90-min educational program classes. The outpatient and domiciliary stages included 45-min TE thrice weekly; creation of a correct functional stereotype; and orthotics. Twenty-six patients received medical therapy only (a control group). The authors estimated tender joint count (TJC), swollen joint count (SJC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), joint pain on 100-mm visual analog scale (VAS), DAS28, HAQ, RAPID3, hand grip strength, average maximum knee extension and ankle flexion by the EN-TreeM movement analysis, and compliance with drug and non-drug treatments. Results. The study group showed a stably high compliance with therapy with disease-modifying antirheumatic drugs, less need for symptomatic agents, higher adherence to the methods of creating a correct functional stereotype, orthotics, and regular TE. Twenty-two patients completed 6-month CRP; 12 patents did not complete the treatment because of non-compliance with nondrug methods, primarily TE. Upon completion of the in-hospital stage of CRP, the study group exhibited significant positive changes in pain and functional status and no significant impact on global inflammatory activity indicators (SJC, ESR, CRP, and DAS28). After 6 months of CRP, there were reductions in TJC by 6.0+1.8 or 72.3% (p <0.01), SJC 4.0+1.2 or 74.1% (p <0.01), ESR by 58.2% (p < 0.01), CRP by 67.2% (p < 0.01), VAS pain by 70.4% (p < 0.01), DAS28 by 1.38+0.21 scores or 31.9% (p < 0.05), HAQ by 0.97+0.56 scores or 75.8% (p < 0.01), and RAPID3 by 5.98+0.92 scores or 60.1% (p < 0.01). The grip strength of a more and less affected hand increased by 44.9% (p < 0.05) and 31.3% (p < 0.05), respectively. The average maximum extension of a weaker and stronger knee joint increased by 88.7% (p < 0.01), and 67.7% (p < 0.01), respectively. The average maximum flexion of a more and less affected ankle joint rose by 81.6% (p < 0.01) and 70.2% (p < 0.01), respectively. Following 6 months, the changes in the control group were less significant, which determined significant differences between the groups in most indicators. Conclusion. Six-month CRP enhances compliance with drug and non-drug treatments, assists in controlling disease activity, and improves functional abilities, motor activity, and quality of life in patients with early RA. The main reason for CRP interruption is inadequate patient adherence to non-drug treatments.