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Goede resultaten van een korte klinische behandeling door een multidisciplinair team bij patienten met reumatoide arthritis; een gerandomiseerd onderzoek (Favourable effect of a short period of inpatient multidisciplinary team core in rheumatoid arthritis: a randomised trial) [Dutch]
Vliet Vlieland TPM, Zwinderman AH, Breedveld FC, Hazes JMW
Nederlands Tijdschrift voor Geneeskunde 1997;141(15):727-731
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To examine the short-term and long-term effects of inpatient multidisciplinary team care for patients with a flare of rheumatoid arthritis (RA) in comparison with regular outpatient care. DESIGN: Randomized controlled trial with follow-up assessments. SETTING: University Hospital, Leiden, and Rheumtology Clinic Sole Mio, Noordwijk, the Netherlands. METHODS: In the period March 1992-December 1993, 108 patients with a flare of rheumatoid arthritis were selected for the study. Twenty-eight of them refused to participate in the study. The other 80 patients were divided into a treatment group of 39 and a control group of 41 patients. The inpatient group received an inpatient multidisciplinary team care programme of 11 days followed by regular outpatient care. The outpatient group received regular outpatient care only. The main outcome measures concerned disease activity (Ritchie index, number of swollen joints, disease activity according to the patient and the physician, pain, ESR), functional (Health assessment questionnaire), and emotional status (Arthritis impact measurement scales, items anxiety and depression), before the treatment and after 2, 4, 12, 52, and 104 weeks. RESULTS: Averaged over the measurements at 2, 52 and 104 weeks, there was a significantly greater improvement in changes from baseline in the inpatient group, concerning swollen and tender joint counts, the patient's assessment of pain, and the patient's and physician's assessments of disease activity (multivariate repeated measures analysis of variance, p < 0.05). The percentage of patients showing a considerable decrease of disease activity according to the American College of Rheumatology criteria for improvement was significantly larger in the inpatient group than in the outpatient group up to and including 52 weeks (p < 0.05). No differences in measures of functional or emotional status were seen over the total follow-up period. CONCLUSION: A short period of inpatient multidisciplinary team care had a more beneficial effect on disease activity over a period of two years than the usual outpatient care by a rheumatologist; it should be considered a useful treatment modality in patients with RA.

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