DiRenzo Dana, Finan Patrick
The Johns Hopkins University, Baltimore, MD, USA.
Curr Treatm Opt Rheumatol. 2019 Jun 15;5:168-178. doi: 10.1007/s40674-019-00123-z. Epub 2019 Apr 30.
There is increasing evidence that adjunctive, non-pharmacologic treatment programs are beneficial in the management of arthritis when added to traditional disease-modifying medications. This review focuses on non-pharmacologic management strategies that impact pain and affect, with a focus on self-efficacy, for those with osteoarthritis (OA) and rheumatoid arthritis (RA).
We reviewed both office-based and internet-based self-management strategies, mindfulness based interventions (MBIs), and cognitive behavioral therapies (CBTs) for patients with arthritis. These behavioral strategies have shown to improve pain, mood disturbance, and physical function in those with both osteoarthritis and rheumatoid arthritis. Improvements in self-efficacy and coping capacity are associated with improvements in patient-reported outcomes (PROs) related to pain and functioning.
Self-management programs, MBIs, and CBTs are more effective at improving pain and mood disturbance compared to usual care for patients with arthritis although high quality randomized controlled trials are lacking. Non-pharmacologic management programs are increasingly available via the internet and mobile applications.
越来越多的证据表明，辅助性非药物治疗方案在与传统改善病情药物联合使用时，对关节炎的管理有益。本综述重点关注影响疼痛和情感的非药物管理策略，尤其关注骨关节炎（OA）和类风湿关节炎（RA）患者的自我效能。
我们回顾了针对关节炎患者的基于门诊和基于互联网的自我管理策略、正念干预（MBIs）和认知行为疗法（CBTs）。这些行为策略已显示可改善骨关节炎和类风湿关节炎患者的疼痛、情绪障碍及身体功能。自我效能和应对能力的改善与患者报告结局（PROs）中与疼痛和功能相关的改善相关。
与关节炎患者的常规护理相比，自我管理方案、MBIs和CBTs在改善疼痛和情绪障碍方面更有效，尽管缺乏高质量的随机对照试验。非药物管理方案越来越多地可通过互联网和移动应用程序获得。
