Is a comprehensive rehabilitation program effective for patients with RA of all levels of disease activity?

This study investigated the effects of a rehabilitation program on pain, quality of life (QoL), and c-reactive protein (CRP) values for patients with rheumatoid arthritis (RA) and different levels of disease activity score (DAS).

The study found that a rehabilitation program significantly improved pain and QoL for patients, regardless of their DAS.

RA is an inflammatory autoimmune disease that can affect several joints in the body. It also tends to progress over time. The symptoms like pain and swelling may increase along with measures of inflammation in the blood such as CRP. In this case, the RA is considered to be active and the patients QoL is increasingly affected by the disease.

DAS28 measures RA activity by considering symptoms in 28 joints and CRP levels. A low DAS28 will mean that the RA is not active. In patients with higher DAS28, this will most likely be reflected in the amount of pain the patient states. Pain is measured by the visual analog scale (VAS). A higher VAS score indicates more pain.

Treatment for RA includes drugs to reduce inflammation and rehabilitation. It is assumed that a rehabilitation program is not as effective for patients with high DAS28-values because it may increase their symptoms and reduce the quality of life. However, there is not yet enough data to support this statement.

In this study, 58 women with RA were included. They participated in a 4-week rehabilitation program. Upon enrollment, VAS, DAS28, CRP levels, and QoL were assessed. The patients were then divided into two groups. Group A had a lower activity of RA disease (DAS28 lower than 4.2). Group B had a higher activity of RA disease (DAS28 4.2 or higher).

The rehabilitation program included adapted treatments like physiotherapy, a gentle exercise program, group classes, therapy in water, and hand therapy. Additional applied treatments were electrotherapy, laser therapy, therapy with ice, and others. Both groups received an average of 5 treatments per day. After completion of the program, the assessment was repeated.

Both groups showed a significant decrease in DAS28. In group A, DAS28 was reduced from an average of 3.5 prior to rehabilitation to an average of 3.0 afterward. In group B DAS28 was reduced from an average of 5.0 prior to rehabilitation to an average of 4.2 afterward.

Pain levels also improved significantly in both groups. Group A had a drop in pain scored from 4.2 to 2.5 after rehabilitation. The pain level in group B reduced significantly from an average of 5.4 to an average of 3.7. CRP-levels did not decrease significantly over the course of the 4-week program. In both groups, a significant improvement in QoL was documented.

The authors recommend implementing a rehabilitation program in the treatment plan for patients with the diagnosis RA as it supports a decrease in the disease activity and the related symptoms regardless of disease activity scores.

The study included only women and the number of patients was comparably low. 

Ask your doctor about the option of a rehabilitation program.