gms | German Medical Science

Introduction: Multimodal rheumatic complex treatment (MRCT) which mainly reflects a special concept of in-patient physical treatment led to an improvement in pain management in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) [1], [2]. This study aimed to determine the effects of MRCT in combination with personalized psychological and nutritional intervention.

Methods: To determine if a personalized expanded MRCT could improve the clinical course in patients, patient-reported outcomes (PRO), clinical activation scores and sera were analyzed in 109 participations [rheumatoid arthritis (RA) n=37; spondyloarthritis (SpA), n=46, psoriatic arthritis (PsA), n=26]. Clinical data (BMI, organ involvement, therapy), PRO [Visual analogue scale – pain (VAS), HAQ-II, PHQ-9, MFI, PsAID], disease activity scores (DAS-28, ASDAS), serological markers (hs-CRP) and functional scores (BASMI) were assessed at the time of starting expanded MRCT and after 15 days of daily standardized 300 min personalized intervention and 6 months after baseline.

Results: At baseline, no clinical differences between the patient groups were apparent. The reported pain at baseline correlated with increased value in HAQ-2 and DAS-28 only in RA and PsA [RA (HAQ-2: r2=0.4917, P=0.0031; DAS-28: 0.4321, P=0.0107); PsA (HAQ-2: r2=0.679, P=0.0003; DAS-28: r2=0.6716, P=0.0002)], in SpA only with ASDAS (r2=0.6271, P<0.0001). Expanded MRCT led to less pain in all groups (day 0 vs. 15: RA: 53.09±19.03 vs. 34.31±21.51, P<0.0001; PsA: 54.20±24.90 vs. 39.60±24.02, P=0.0004; SpA: 59.55±19.58 vs. 44.26±21.85, P<0.0001), especially in SpA the improvement expanded up to 6 months (P=0.0252). PHQ-9 and DAS-28 displayed reduced values after expanded MRCT in RA and PsA following the intervention [RA (PHQ-9: 8.42±5.30 vs. 5.31±4.89, P=0.0002; DAS-28: 3.64±0.92 vs. 2.72±0.88 P<0.0001); PsA (PHQ-9: 8.65±4.52 vs. 6.04±4.45, P=0.0016; DAS-28: 3.55±0.98 vs. 2.70±0.99, P<0.0001)]. In contrast to RA and PsA, in SpA the improvement according to the ASDAS was still detectable after 6 months (day 0 vs. 15: 2.90±0.87 vs. 2.47±0.87, P=<0.0001; vs. 185: 2.21±0.75, P=0.0265).

Conclusion: Personalized psychological and nutritional intervention increased the benefits of MRCT with respect to pain management and disease activity for RA, PsA and SpA patients. In the latter cohort, beneficial effects were observed over a time period of 6 months.