A randomized trial of three psychosocial treatments for the symptoms of rheumatoid arthritis

Semin Arthritis Rheum. 2010 Dec;40(3):222-32. doi: 10.1016/j.semarthrit.2010.04.001.


Objective: To assess and compare the benefits of 3 psychosocial treatments for rheumatoid arthritis (RA).

Methods: RA patients were randomized to cognitive-behavior therapy (CBT), relaxation response training (RR), or arthritis education (AE). All treatment was conducted in groups. Follow-up occurred immediately after treatment and 6 and 12 months later. Pain, other RA symptoms, role impairment, and psychological distress were assessed with standardized self-report questionnaires. Arthritis severity and activity were assessed with a joint examination, erythrocyte sedimentation rate, grip strength, and walking time. An intent-to-treat analytic strategy was employed. Linear regression was used to establish treatment effect on pain and other RA symptoms, while adjusting for sociodemographic and clinical variables.

Results: One hundred sixty-eight patients were randomized. Pain improved significantly at 12 months in the RR and AE groups and showed a nonsignificant positive trend with CBT. Other RA symptoms improved significantly with CBT and AE and showed a nonsignificant trend with RR. There were no significant differences in the outcomes across the 3 treatment groups. When the results for all 3 groups were aggregated, significant benefits were found for pain, other RA symptoms, self-care activities, and social activities. Effect sizes ranged between 0.26 and 0.35.

Conclusions: These 3 psychosocial treatments were beneficial, with treatment effect sizes in the small to moderate range. The effects appeared immediately after treatment and were generally sustained at long-term follow-up. These benefits were achieved over and above those resulting from medical management. These treatments constitute an effective augmentation to standard medical therapy for RA patients.

Trial registration: ClinicalTrials.gov NCT00056667.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Arthritis, Rheumatoid / psychology*
  • Arthritis, Rheumatoid / therapy*
  • Cognitive Behavioral Therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Linear Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Patient Education as Topic*
  • Psychology
  • Relaxation Therapy*
  • Severity of Illness Index
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT00056667