QUESTION: Does the addition of cognitive behavioural therapy (CBT) to medical management relieve symptoms and reduce disability and psychological distress in patients with recent onset rheumatoid arthritis (RA)?
Design
Randomised {allocation concealed} (*), blinded (outcome assessor), controlled trial with 6 months of follow up.
Setting
Rheumatology clinics at 3 hospitals in or near London, UK.
Patients
56 patients who were 18-75 years of age, had had definite or classic RA for <2 years, and tested seropositive for RA. Exclusion criteria were history of mental illness or alcohol or drug abuse, or insufficient fluency in English. Follow up was 80% (mean age 55 y, 71% women, mean duration of illness 12.6 mo).
Intervention
Patients were allocated to routine medical management and CBT (n = 23) or routine medical management alone (n = 22). 2 psychologists provided CBT according to a treatment manual during eight 1 hour therapist-client sessions over 8 weeks. The programme included an educational component plus the following self management skills: relaxation training, attention diversion, goal...