A randomized trial of three psychosocial treatments for the symptoms of rheumatoid arthritis.
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.
Barsky
Arthur J
AJ
Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Ahern
David K
DK
Orav
E John
EJ
Nestoriuc
Yvonne
Y
Liang
Matthew H
MH
Berman
Ilana T
IT
Kingsbury
Joshua R
JR
Sy
Jennifer T
JT
Wilk
Kathryn G
KG
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000523:psychology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011584:Psychology; D012064:Relaxation Therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome