Cognitive-behavioral treatment in unselected rheumatoid arthritis outpatients

Objective : This trial was performed to evaluate the efficacy of an adjunct ive cognitive-behavioral treatment compared with rheumatological treatment alone in unselected rheumatoid arthritis outpatients. Design: A prospective randomized control design was used. Change in medicat ion during treatment was controlled by matching therapy- and control-group subjects according to this change in medication, sex, age, duration of dise ase, and functional class, Setting: A rheumatological outpatient clinic, University of Goettingen, Ger many. Patients: Fifty-five consecutive outpatients with a diagnosis of rheumatoid arthritis (age 52.7 years, 74.5% female, duration of disease 9.4 years) fi nished the study. Interventions: Subjects received routine care by the rheumatologists and ro utine medical treatment. Cognitive-behavioral treatment subjects (n = 19) r eceived adjunctive standardized cognitive-behavioral group treatment with 1 2 weekly sessions. Outcome Measures: Outcome measures included disease activity variables, pai n variables (pain intensity, affective pain), psychological symptoms, and c oping. Results: Subjects mostly demonstrated an increasing disease activity during treatment, change in medication during treatment was necessary in some pat ients. In the cognitive-behavioral treatment group the course of rheumatoid arthritis seemed less progressive than in the control group. The core effe cts of cognitive-behavioral treatment pertain more to improved coping, emot ional stabilization, and reduced impairment than to reduced pain intensity. Passive, emotion-focused coping, helplessness, depression, anxiety, affect ive pain, and fluctuation of pain are reduced, "Acceptance of Illness" is i mproved. Conclusions: Cognitive-behavioral therapy has proven an effective adjunct t o standard treatment of rheumatoid arthritis outpatients. These effects wer e shown in an unselected sample with increasing disease activity and with c omparable changes in medication during treatment. We recommend cognitive-be havioral treatment as an desirable adjunct to standard medical treatment of rheumatoid arthritis.