Patients with rheumatoid arthritis with moderate or high disease activity benefit from multidisciplinary rehabilitation: a nested case-control study

Background: rheumatologists recognize the importance of rehabilitation in patients with rheumatoid arthritis (RA), but they are not confident if patients with significant disease activity would benefit from it. Objective: To verify if rheumatoid arthritis patients with moderate to severe inflammatory activity (MHA) improve functional capacity (FC) after a comprehensive rehabilitation program. Methods: Nested case-control study. RA patients who completed a rehabilitation program between June 2014 and December 2017 were included. The interventions were prescribed according to the rehabilitation team's discretion. FC was assessed with Health Assessment Questionnaire Disability Index (HAQ) and compared between before and after interventions. The group which improved at least 50% in CDAI was compared to the group which achieved <50%. Results: We included 46 patients with complete HAQ and baseline CDAI data, with a mean age of 53.6 years and a mean disease duration of 11.8 years. HAQ and CDAI improved on average 0.481 (0.500) and 14.2 (16.7), respectively. Patients who improved CDAI tended to have a greater mean HAQ difference (0.6 vs. 0.3; p = 0.058). Conversely, patients who did not improve disease activity had a HAQ reduction of 0.3 (0.4). Post-hoc analysis was performed on the group of 9 patients with baseline CDAI [≤]10. A mean baseline CDAI of 5.2 and a mean HAQ difference of 0.319 (0.079; 0.56; p = 0.016) were found. Conclusions: After rehabilitation, RA patients with sustained MHA improved FC similarly to patients with baseline mild activity or remission. Thus, patients with RA and MHA may benefit from rehabilitation concurrently with drug treatment. This study suggests that the range of improvement in FC with rehabilitation appears to have an additive effect to the drug therapy.