- •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.
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).
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.
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.
MRCT as a multimodal treatment concept with a strong emphasis on PT reduces pain in SpA meaningfully and facilitates reduced analgesic usage.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Internal Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection.Ann Rheum Dis. 2009; 68: 777-783https://doi.org/10.1136/ard.2009.108233
- The Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general.Ann Rheum Dis. 2011; 70: 25-31https://doi.org/10.1136/ard.2010.133645
- EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update.Ann Rheum Dis. 2020; 79: 700-712https://doi.org/10.1136/annrheumdis-2020-217159
- Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force.Ann Rheum Dis. 2018; 77: 3-17https://doi.org/10.1136/annrheumdis-2017-211734
- Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritis.Ann Rheum Dis. 2020; 79: 193-201https://doi.org/10.1136/annrheumdis-2019-216034
- Efficacy and safety of non-pharmacological and non-biological pharmacological treatment: a systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis.RMD Open. 2017; 3e000397https://doi.org/10.1136/rmdopen-2016-000397
- Assessing the effect of interventions for axial spondyloarthritis according to the endorsed ASAS/OMERACT core outcome set: a meta-research study of trials included in Cochrane reviews.Arthritis Res Ther. 2020; 22: 177https://doi.org/10.1186/s13075-020-02262-4
- 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis.Ann Rheum Dis. 2017; 76: 978-991https://doi.org/10.1136/annrheumdis-2016-210770
- Efficacy of intensive physiotherapy in combination with low-dose etanercept in active spondyloarthritis: A monocentric pilot study.J. Rheumatol. 2014; 41: 1897-1898
- EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis.Ann Rheum Dis. 2018; 77: 797-807https://doi.org/10.1136/annrheumdis-2017-212662
- Rheumatic diseases and molecular physical medicine – new aspects.Phys Medizin Rehabil Kurortmedizin. 2017; 27: 205-210https://doi.org/10.1055/s-0043-113045
- Serial locally applied water-filtered infrared a radiation in axial spondyloarthritis – a randomized controlled trial.Int J Hyperth. 2020; 37: 965-970https://doi.org/10.1080/02656736.2020.1804079
- Complex and multimodal rheumatologic treatment (OPS 8-983) – challenges, solutions and perspectives.Z. Rheumatol. 2005; 64: 557-563
- Complex treatments in rheumatology and geriatrics – Challenges – Differences – Chances.Z Rheumatol. 2018; 77: 385-396https://doi.org/10.1007/s00393-018-0470-1
- Evaluation of a special concept of physical therapy in spondyloarthritis: German multimodal rheumatologic complex treatment for spondyloarthritis.Clin Rheumatol. 2020; 39: 1513-1520https://doi.org/10.1007/s10067-019-04887-6
- Measurement of patient outcome in arthritis.Arthritis Rheum. 1980; 23: 137-145https://doi.org/10.1002/art.1780230202
- Vergleichende evaluation einer deutschen version des Health Assessment Questionnaires (HAQ) und des Funktionsfragebogens Hannover (FFbH).Z Rheumatol. 1997; 56: 144-155https://doi.org/10.1007/s003930050030
- A new approach to defining functional ability in ankylosing spondylitis: The development of the bath ankylosing spondylitis functional index.J Rheumatol. 1994; 21: 2281-2285
- Validation of the 28-joint Disease Activity Score (DAS28) and European League Against Rheumatism response criteria based on C-reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on erythr.Ann Rheum Dis. 2009; 68: 954-960https://doi.org/10.1136/ard.2007.084459
- Modified disease activity scores that include twenty-eight-joint counts development and validation in a prospective longitudinal study of patients with rheumatoid arthritis.Arthritis Rheum. 1995; 38: 44-48https://doi.org/10.1002/art.1780380107
- Simultaneous inference in general parametric models.Biometrical J. 2008; 50: 346-363https://doi.org/10.1002/bimj.200810425
- Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: a randomized controlled trial.Arthritis Rheum. 2001; 45: 430-438
- The compelling link between physical activity and the body's defense system.J Sport Heal Sci. 2019; 8: 201-217https://doi.org/10.1016/j.jshs.2018.09.009
- Effects of whole body hyperthermia on plasma cortisol, total lymphocytes and -subpopulation in patients with ankylosing spondylitis and healthy controls.Phys Medizin Rehabil Kurortmedizin. 2005; 15: 44-47https://doi.org/10.1055/s-2004-834601
Published online: August 02, 2021
Accepted: July 15, 2021
Received in revised form: July 5, 2021
Received: May 25, 2021
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.