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Multimodal rheumatologic complex treatment in patients with spondyloarthritis - a prospective study

  • Philipp Klemm
    Correspondence
    Corresponding author at: Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany.Contributed equally.
    Affiliations
    Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
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  • Paulina Preusler
    Correspondence
    Contributed equally.
    Affiliations
    Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
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  • Ole Hudowenz
    Affiliations
    Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
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  • Thomas Asendorf
    Affiliations
    Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
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  • Ulf Müller-Ladner
    Affiliations
    Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
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  • Elena Neumann
    Affiliations
    Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
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  • Uwe Lange
    Affiliations
    Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
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  • Ingo H. Tarner
    Affiliations
    Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
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Published:August 02, 2021DOI:https://doi.org/10.1016/j.ejim.2021.07.005

      Key-points

      • The importance of non-pharmaceutical treatment modalities in addition to medical treatment is increasingly recognized in recent years. Importantly, non-pharmaceutical treatment modalities are already recommended in various treatment guidelines in spondyloarthritis for many years.So far MRCT has shown to be effective in treating spondylarthritis (SpA) in a retrospective study
      • Multimodal rheumatologic complex treatment (MRCT) is a treatment modality, which is established in the German health system, but due to its multidisciplinary approach and an emphasis on non-pharmaceutical treatments an important blueprint for similar approaches that exist in various countries.
      • Carefully conducted studies on this topic are rare, but are very important to guide health management strategies and future treatment recommendations.
      • This study aimed to assess effects prospectively sponsoring a follow-up period of 12 weeks after MRCT to assess long-term effects
      • MRCT reduces pain in patient with SpA significantly and in a clinical meaningful manner and allows for a reduced use of analgesics with detectable positive effects 12 weeks after discontinued therapy
      • The study provides new data on an important topic on disease management which is underrepresented in the current scientific literature.

      Abstract

      Introduction

      Aim of this study was to prospectively assess the effects of multimodal rheumatologic complex treatment (MRCT), a special concept of in-patient physical treatment (PT) for treating spondyloarthritis (SpA), namely radiographic (r-) and non-radiographic (nr-) axial (ax-) SpA and psoriatic arthritis (PsA).

      Methods

      r-, nr-axSpA and PsA patients receiving a 16-day MRCT were eligible. MRCT was delivered to participants over 64 PT sessions of various modalities with a minimum of 1,400 min of treatment. Primary outcome was a change in pain levels measured on a numeric rating scale (NRS, 0 - 10) between baseline and discharge. Secondary outcomes were assessments of i) disease activity ii) functional disabilities iii) serum cytokine levels iv) analgesic usage v) patient global health assessment and patients’ satisfaction with their therapeutic response to MRCT from baseline to discharge and over a 12-week follow-up.

      Results

      50 patients completed the study and were analysed. Pain levels were improved significantly (p < 0.001, 95% confidence interval -2.25 to -0.8,). Further analyses revealed no influencing factors or relevant inter-group differences. Positive effects of MRCT lasted up to 12 weeks after discharge. Analgesic usage was reduced compared to baseline. Patient global health assessment continued to be improved throughout the whole follow-up. No MRCT-related harms were recorded.

      Conclusion

      MRCT as a multimodal treatment concept with a strong emphasis on PT reduces pain in SpA meaningfully and facilitates reduced analgesic usage.

      Keywords

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