FRI0684 Efficiency of complex rehabilitation program in patients with rheumatoid arthritis receiving abatacept
Authors: E. Orlova, D. Karateev, A. Kochetkov
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> Rehabilitation techniques (physical exercises, physiotherapy, occupational therapy, patient education) help to manage rheumatoid arthritis (RA) in addition to drug treatment [1–4]. <h3>Objectives:</h3> To evaluate the efficiency of 12-month complex rehabilitation program in patients with RA receiving abatacept. <h3>Methods:</h3> 50 patients with RA (94% females, 72% with moderate disease activity by DAS28, age of 18 to 57 years, disease duration of 10 months to 12 years) were included and randomized into 2 groups. All patients received abatacept (intravenously 10 mg/kg (mean 750 mg) once every 4 weeks or subcutaneously 125 mg once a week) with methotrexate 20–25 mg per week. 28 study group patients underwent 12-months complex rehabilitation program: laser therapy of 12 to 16 min (infrared low intensity laser radiation, wavelength of 0,89 micrometers, pulse frequency of 1000 to 1500 Hz) for hand, knee, ankle, shoulder and elbow joints, 3 courses for 14 sessions with a mean interval of 3,2 months; 45-min dynamic exercises using gym apparatus Enraf-Nonius under the supervision of a trainer 3 times a week; 45-min exercises for hands 3 times a week; 45-min occupational therapy (joint protection strategies, use of assistive devices and adaptive equipment), 10 sessions; wrist, ankle and knee orthoses, orthopedic insoles; education program (4 daily 90-min studies). 22 patients received only drug therapy (control). Tender and swollen joint count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), joint pain on 100-mm VAS, DAS28, HAQ, RAPID3, hand grip strength, the average powers of knee extension and ankle flexion by EN-TreeM movement analysis were evaluated at baseline and at 12 months. <h3>Results:</h3> After 12 month in the study group tender joint count decreased by 69,3% (»&lt;0,01), swollen joint count – by 66,2% (»&lt;0,01), ESR – by 63,7% (»&lt;0,01), CRP – by 58,5% (»&lt;0,01), pain on VAS – by 82,3% (»&lt;0,01), DAS28 – by 39,6% (▵DAS28=2,89±0,99, »&lt;0,05), HAQ – by 72,2% (▵HAQ=1,73±0,44, »&lt;0,01), RAPID3 – by 78,3% (▵RAPID3=8,45±0,85, »&lt;0,01). The grip strength of a more affected hand enhanced by 57,1% (»&lt;0,01), of a less affected – by 46,2% (»&lt;0,05). The average extension power of a weaker knee increased by 72,1% (»&lt;0,01), of a stronger – by 65,8% (»&lt;0,01). The average flexion power of a more affected ankle joint elevated by 48,9% (»&lt;0,05), of a less affected – by 69,4% (»&lt;0,01). In the study group there were statistically significant differences from the control group in the most parameters (»&lt;0,05), excluding CRP, ESR, DAS28 and the average flexion power of a more affected ankle joint (»&gt;0,05). After 12-months in the study group there was significantly more frequently a good response to treatment according to the EULAR criteria (DAS28) (85,7% vs 63,6% in the control group, »&lt;0,05). <h3>Conclusions:</h3> 12-month complex rehabilitation program relieves pain, improves quality of life, functional status, motion activity and helps to control disease activity in patients with RA receiving abatacept. <h3>References</h3> [1] Forestier R, et al. Joint Bone Spine2009;76(6):691–8. [2] Hurkmans EJ, et al. Acta Reumatol Port2011;36(2):146–58. [3] Vliet Vlieland TPM. Best Pract Res Clin Rheumatol2009;23(1):103–16. [4] Vliet Vlieland TPM, van den Ende CH. Curr Opin Rheumatol2011;23(3):259–64. <h3>Disclosure of Interest:</h3> None declared