Patient education is recommended for patients with rheumatoid arthritis. The recommendation is strong, because the information provided to the patient is also a prerequisite for shared, informed decision-making together with the treating physician.
In a review published in 2003 «Riemsma RP, Taal E, Kirwan JR ym. Systematic revie...»1, the effects of patient education on the health status of patients with rheumatoid arthritis were evaluated. A total of 31 randomized controlled trials were included in the review. The educational interventions varied widely in content, and the patient populations differed across studies.
Patient education was found to have a significant beneficial effect on physical functioning, the number of tender and swollen joints, patients' global assessment of disease severity, psychological status, and the occurrence of depression at the first follow-up assessment, conducted after interventions lasting from 3 weeks to 9 months. The difference compared with control groups was most pronounced in behavioural treatment studies, in which the interventions varied considerably (e.g. physical exercise, relaxation, pain management, biofeedback). No significant effects were observed for anxiety or disease activity. At the final follow-up visit, no statistically significant differences were found, although a trend favouring improved physical functioning was noted.
In a randomized controlled trial «Grønning K, Rannestad T, Skomsvoll JF ym. Long-ter...»2, patients with rheumatoid arthritis, psoriatic arthritis and unspecified polyarthritis were randomised to a nurse-led hospital-based patient education programme combining group and individual education (the intervention group) (n = 71) or a waiting list (n = 70).
After 12 months, the intervention group had a statistically significant higher global well-being than the controls, mean change score 8.2 (95 % CI 1.6–14.8; p-value = 0.015). DAS28–3 showed a statistically significant improvement in, mean change -0.3 (95 % CI -0.5 – -0.1; p-value = 0.001), in the intervention group from baseline to 12 months, but not in the controls. The controls had a statistically significant deterioration in the Arthritis Self-Efficacy Other Symptoms Subscale, mean change -5.0 (95 % CI -8.6 – -1.3; p-value = 0.008), Arthritis Impact Measurement Scales - 2 Social, mean change 0.3 (95 % CI 0.1–0.5; p-value = 0.008), and Hospital Anxiety and Depression Scale total, mean change 1.4 (95 % CI 0.3–2.5; p-value = 0.013).
A randomized controlled trial «Arvidsson S, Bergman S, Arvidsson B ym. Effects of...»3 was performed to evaluate the effects of a self-care promoting problem-based learning programme for people with rheumatic diseases in terms of health-related quality of life, empowerment, and self-care ability. The participants were randomly assigned to either the experimental group (n = 54) or the control group (n = 148). The programme was running alongside the standard care the participants received at a rheumatology unit. The participants in the experimental group had statistically significant stronger empowerment after participation in the self-care promoting problem-based learning programme compared with the control group, at the 6-month post-intervention.
In a non-blinded randomized controlled trial «John H, Hale ED, Treharne GJ ym. A randomized cont...»4 with a delayed intervention arm. A total of 110 participants were randomly assigned to receive the cognitive behavioural education intervention to address the cardiovascular aspects of rheumatoid disease (n = 52) or a control information leaflet (n = 58).
At 6 months, those in the intervention group had significantly higher knowledge scores (P < 0.001); improved behavioural intentions to increase exercise (P < 0.001), eat a low-fat diet (P = 0.01) and lose weight (P = 0.06); and lower mean diastolic blood pressure by 3.7 mmHg, whereas the control group's mean diastolic blood pressure increased by 0.8 mmHg. There was no difference between the groups on actual behaviours.
Patients with rheumatoid arthritis, psoriatic arthritis and unspecified polyarthritis were randomised to an educational programme (n = 71) or usual care (n = 70). The programme consisted of three group educational sessions followed by one individual educational session «Grønning K, Skomsvoll JF, Rannestad T ym. The effe...»5.
After four months the intervention group had significantly better global well-being, 95 % CI (2.3–14.1), p = 0.01, and self-efficacy, 95 % CI (0.2–8.1), p = 0.04, than the control group. There were also trends for improved disease activity, and a statistically significant improvement in patient activation and pain in the intervention group.
In a randomised, blind, controlled trial «Mathieux R, Marotte H, Battistini L ym. Early occu...»6 60 patients with early RA were divided into 2 groups. At baseline, group 1 received a full early occupational therapy information programme and group 2 received no information. In an extension phase, patients in group 2 received the full information programme at 3 months and were assessed at 6 months.
At 3 months, grip strength of the dominant and non-dominant hands increased more in group 1 than in group 2 (p = 0.021 and 0.047 respectively). HAQ score decreased more in group 1 than in group 2 (p < 0.001). In the extension phase, changes in grip strength and HAQ score in group 2 were similar to those seen in group 1 between baseline and 3 months.
In this randomized, prospective, controlled trial «Giraudet-Le Quintrec JS, Mayoux-Benhamou A, Ravaud...»7104 patients with RA (ACR criteria) were allocated into an educational intervention consisted of 8 weekly ambulatory sessions, each lasting 6 hours and 104 to usual care. After 1 year, statistically significant differences in favour of the education group were found in patient coping (-1.22 ± 5.55 vs -0.22 ± 3.81; p = 0.03), knowledge (3.42 ± 4.73 vs 0.73 ± 3.78; p < 0.0001), and satisfaction (10.07 ± 11.70 vs 5.72 ± 13.77; p = 0.02. No difference was observed in change in HAQ score: -0.04 ± 0.46 (education group) vs -0.06 ± 0.47 (control group) (p = 0.79).
In a randomized controlled trial «Kirwan JR, Hewlett S, Cockshott Z ym. Clinical and...»8 79 RA patients drawn from hospital outpatient clinics were allocated in either observation or observation plus an educational intervention of five sessions (12.5 hours) designed to enhance self-management. Pain and self-efficacy for pain at 0, 4, 8 and 36 weeks were the primary outcome measures. Knowledge of RA and its treatment was measured at 0 and 4 weeks using a multiple-choice questionnaire.
Sixty-eight patients provided adequate data. In those randomized to education, knowledge of RA and its treatment increased by 18 % compared to 9 % in controls (p = 0.058). Self-efficacy for pain improved between weeks 0 and 4 by 10.3 % (p = 0.015) in those offered education, and by 14.1 % in those who were offered and accepted education (p = 0.001) but the difference from controls was not maintained after four weeks.
In a randomized, controlled, assessor-blinded trial «Hammond A, Freeman K. The long-term outcomes from ...»9 65 patients with rheumatoid arthritis less than five years since diagnosis were allocated attend a joint protection and 62 a standard programmes. Both were 8-hour interventions. The standard arthritis education programme, included 2.5 hours of joint protection based on typical UK occupational therapy practice plus 5.5 hours on RA, exercise, pain management, diet and foot care; the joint protection programme used educational-behavioural training.
At four years, the joint protection group had significantly better: joint protection adherence (p = 0.001); early morning stiffness (p = 0.01); AIMS2 activities of daily living (ADL) scores (p = 0.04) compared with the standard group. The joint protection group also had significantly fewer hand deformities: metacarpophalangeal (MCP) (p = 0.02) and wrist joints (p = 0.04).
In a meta-analysis published in 2022 «Wu Z, Zhu Y, Wang Y, et al. The Effects of Patient...»10, the effects of patient education on physical functioning, disease activity, erythrocyte sedimentation rate (ESR), C‑reactive protein (CRP), pain, other symptoms, and patients' global assessment of well-being in individuals with rheumatoid arthritis were evaluated. In addition, the effects on anxiety and depression were assessed.
The meta-analysis included 24 randomized controlled trials (n = 2,276) published between 1991 and 2021. The mean age of the participants ranged from 44 to 69 years.
The patient education interventions varied considerably. Information on rheumatoid arthritis, pharmacological treatment, physical activity, the role of lifestyle factors in rheumatoid arthritis, and self-management strategies was provided through written materials, lectures, group-based education, or telephone counseling. The number of educational sessions varied between studies.
Patient education was associated with beneficial effects on physical functioning, disease activity, pain, and patients' global assessment of rheumatoid arthritis activity. No statistically significant effects were observed for anxiety, depression, or inflammatory biomarkers.
In a meta-analysis published in 2024 «Bounabe A, Elammare S, Janani S, et al. Effectiven...»11, the effects of patient education on the quality of life of patients with rheumatoid arthritis were evaluated.
The meta-analysis included studies published between 1985 and 2022, of which 59 were randomized controlled trials and seven were non-randomized controlled studies (N = 9,622). The mean age of participants ranged from 33 to 65 years.
Patient education methods varied across the studies. Study populations also differed with respect to factors such as patient age, duration of follow-up, and disease duration.
Patient education was found to have a positive effect on quality of life in patients with rheumatoid arthritis. Educational interventions initiated relatively early were associated with more favourable outcomes compared with education started later. In addition, longer-term education was more meaningful than short-term interventions. In studies with a higher proportion of female participants, patient education was perceived as beneficial. A combination of group-based and individual education had a more favourable effect than either group-based or individual education alone. Patient education had a more positive impact on younger individuals compared with older patients.
EULAR has also given advices of the implementation of the EULAR recommendations for patient education «Jones B, Bennett S, Larsson I, et al. Disseminatin...»15.
Parts of the text were translated from Finnish into English using artificial intelligence. The translation was reviewed by an expert.