A Randomized Trial of Three Psychosocial Treatments for the Symptoms of Rheumatoid Arthritis

作者：Barsky Arthur J^*; Ahern David K; Orav E John; Nestoriuc Yvonne; Liang Matthew H; Berman Ilana T; King**ury Joshua R; Sy Jennifer T; Wilk Kathryn G

来源：Seminars in Arthritis and Rheumatism, 2010, 40(3): 222-232.

DOI：10.1016/j.semarthrit.2010.04.001

• rheumatoid arthritis
• cognitive treatment
• symptoms
• pain

Objective: To assess and compare the benefits of 3 psychosocial treatments for rheumatoid arthritis (RA).
Methods: RA patients were randomized to cognitive-behavior therapy (CBT), relaxation response training (RR), or arthritis education (AE). All treatment was conducted in groups. Follow-up occurred immediately after treatment and 6 and 12 months later. Pain, other RA symptoms, role impairment, and psychological distress were assessed with standardized self-report questionnaires. Arthritis severity and activity were assessed with a joint examination, erythrocyte sedimentation rate, grip strength, and walking time. An intent-to-treat analytic strategy was employed. Linear regression was used to establish treatment effect on pain and other RA symptoms, while adjusting for sociodemographic and clinical variables.
Results: One hundred sixty-eight patients were randomized. Pain improved significantly at 12 months in the RR and AE groups and showed a nonsignificant positive trend with CBT. Other RA symptoms improved significantly with CBT and AE and showed a nonsignificant trend with RR. There were no significant differences in the outcomes across the 3 treatment groups. When the results for all 3 groups were aggregated, significant benefits were found for pain, other RA symptoms, self-care activities, and social activities. Effect sizes ranged between 0.26 and 0.35.
Conclusions: These 3 psychosocial treatments were beneficial, with treatment effect sizes in the small to moderate range. The effects appeared immediately after treatment and were generally sustained at long-term follow-up. These benefits were achieved over and above those resulting from medical management. These treatments constitute an effective augmentation to standard medical therapy for RA patients.

• 出版日期2010-12