title: Psychosocial interventions as adjunct therapy for patients with rheumatoid arthritis: a systematic review.
abstract: OBJECTIVE
  To identify the psychological interventions for which there is consistent, high quality evidence of efficacy in the treatment of patients with rheumatoid arthritis (RA).
  
  
  METHODS
  A computer-aided search and manual screening of identified papers was conducted. Randomised controlled trials published in English in peer-reviewed journals, assessing the use of psychological interventions in adult patients with RA were included.
  
  
  RESULTS
  Thirty-four papers published between 1981 and 2009 encompassing 31 studies with 2021 patients were included. There is consistent supportive evidence for the efficacy of disclosure therapy (four studies) and cognitive behavioural therapy (CBT) with maintenance therapy (five studies). There is supportive evidence for improvement with CBT of greater than 6 weeks duration (six studies) in the short-term but conflicting evidence for its long-term efficacy. There is some evidence for improvement with biofeedback-based interventions (two studies). There is conflicting evidence for the benefits of counselling (three studies), psychotherapy (two studies) mindfulness and meditation (two studies), and CBT of less than 6 weeks duration (six studies). There is limited evidence regarding relaxation therapy (two studies). Methodological limitations of the reviewed literature included failure of allocation concealment, blinding and conduction of intention-to-treat analysis, as well as the heterogeneity and choice of outcome measures.
  
  
  CONCLUSIONS
  This review shows consistent supportive evidence for the use of disclosure therapy, and CBT with maintenance therapy as adjunct therapies in patients with RA. It also highlights methodological limitations in the current literature and the need for future research in this area.
authors.affiliation: Department of Medicine, Concord General Repatriation Hospital, Concord, Prince of Wales Hospital, Randwick, NSW, Australia. kumari_d_@hotmail.com
authors.forename: Rukmal Kumari
authors.initials: RK
authors.lastname: Dissanayake
authors.forename: James V
authors.initials: JV
authors.lastname: Bertouch
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D001676:Biofeedback, Psychology; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D006801:Humans; D011613:Psychotherapy / Q000379:methods; D016896:Treatment Outcome; D014342:Truth Disclosure
chemical_list: D018501:Antirheumatic Agents