A blind, randomized, controlled trial of cognitive-behavioural intervention for patients with recent onset rheumatoid arthritis: preventing psychological and physical morbidity

This study examined the efficacy of a cognitive and behavioural interventio n (CBT) for patients with recent onset, seropositive rheumatoid arthritis. Fifty-three participants with a diagnosis of classical or definite rheumato id arthritis, who were seropositive and had less than 2 years of disease hi story were recruited into the trial. All participants received routine medi cal management during the study, although half were randomly allocated to r eceive an adjunctive psychological intervention. All pre- and post-treatmen t assessments were conducted blind to the allocation. Analyses were conduct ed of treatment completers and also by intention-to-treat. Significant diff erences were found between the groups at both post-treatment and 6-month fo llow-up in depressive symptoms. While the CBT group showed a reduction in d epressive symptoms, the same symptoms increased in the Standard group. At o utcome but not follow-up, the CBT group also showed reduction in C-reactive protein levels. However, the CBT group did show significant improvement in joint involvement at 6-month follow-up compared with the Standard group, i ndicating physical improvements above those achieved with standard care. Th ese results: indicate that cognitive-behavioural intervention offered as an adjunct to standard clinical management early in the course of RA is effic acious in producing reductions in both psychological and physical morbidity (C) 2001 International Association for the Study of Pain. Published by Els evier Science B.V. All rights reserved.