SAT0617 12-Month Complex Rehabilitation Program for Rheumatoid Arthritis Patients Receiving Biologic Dmards

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.

References

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