Triantafyllias K, Sauer C, Schwarting A
Rheumazentrum Rheinland-Pfalz GmbH, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Deutschland.
Innere Medizin, Krankenhaus Sachsenhausen, DGD Kliniken, Frankfurt am Main, Deutschland.
Z Rheumatol. 2022 Sep;81(7):596-604. doi: 10.1007/s00393-022-01209-1. Epub 2022 May 9.
The concept of complex multimodal rheumatologic treatment (CMRT) has been established for several years in German rheumatologic departments and aims at a multifaceted therapeutic approach to patients with rheumatic diseases. Objective of this study was to examine the therapeutic effect of CMRT in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) in an acute rheumatology center.
The treatment success of CMRT was evaluated by epidemiologic data, patient questionnaires on visual analog scales (VAS) regarding morning stiffness, pain and disease activity (DA), as well as clinical scores (Disease Activity Score 28 [DAS28], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI]), laboratory inflammation markers (CRP, erythrocyte sedimentation rate) and medication in three visits: visit 1 = begin of CMRT; visit 2 = end of CMRT; visit 3 = 3 months after CMRT.
In this study 162 patients from the Rheumatology Center, Rhineland-Palatinate, Germany (96 (59.3%) RA, 30 (18.8%) AS, 36 (22.2%) PsA) were recruited. Statistical examinations revealed a significant improvement of VAS(DA) (visit 2 versus visit 1: RA: p = 0.02, AS: p < 0.001, PsA: p < 0.001), morning stiffness (RA: p < 0.001, AS: p = 0.03, PsA: p < 0.001) and patient reported pain (all; p < 0.001) in the context of CMRT. In the RA and AS subgroups improvements of DAS28 and BASDAI could also be observed (visit 2 versus visit 1: both; p < 0.001). Moreover, significant improvement of patient reported outcomes could be observed 3 months after CMRT regarding VAS(DA) (RA: p = 0.02 und AS: p = 0.03, morning stiffness (PsA: p = 0.02) and patient reported pain (RA: p = 0.01)). Interestingly, subgroup analyses showed that the therapeutic benefit was independent of the concomitant pharmacotherapy.
The results of this study suggest a therapeutic benefit for patients being treated by CMRT and highlight the high value of this therapeutic concept in patients with systemic-inflammatory rheumatic diseases.
复杂多模式风湿病治疗（CMRT）的概念在德国风湿病科室已确立数年，旨在对风湿病患者采取多方面的治疗方法。本研究的目的是在一家急性风湿病中心检验CMRT对类风湿关节炎（RA）、强直性脊柱炎（AS）和银屑病关节炎（PsA）患者的治疗效果。
通过流行病学数据、患者关于晨僵、疼痛和疾病活动度（DA）的视觉模拟量表（VAS）问卷，以及临床评分（疾病活动度评分28 [DAS28]、巴斯强直性脊柱炎疾病活动指数 [BASDAI]、巴斯强直性脊柱炎功能指数 [BASFI]）、实验室炎症指标（CRP、红细胞沉降率）和用药情况，在三次就诊时评估CMRT的治疗效果：就诊1 = CMRT开始时；就诊2 = CMRT结束时；就诊3 = CMRT后3个月。
本研究招募了德国莱茵兰 - 普法尔茨州风湿病中心的162例患者（96例（59.3%）RA、30例（18.8%）AS、36例（22.2%）PsA）。统计学检验显示，在CMRT过程中，VAS（DA）（就诊2与就诊1相比：RA：p = 0.02，AS：p < 0.001，PsA：p < 0.001）、晨僵（RA：p < 0.001，AS：p = 0.03，PsA：p < 0.001）和患者报告的疼痛（所有患者；p < 0.001）均有显著改善。在RA和AS亚组中，也观察到DAS28和BASDAI有所改善（就诊2与就诊1相比：两者均；p < 0.001）。此外，在CMRT后3个月，在VAS（DA）（RA：p = 0.02，AS：p = 0.03）、晨僵（PsA：p = 0.02）和患者报告的疼痛（RA：p =
