ABSTRACT
Background: Multimodal rheumatologic complex treatment (MRCT) is a treatment concept for patients with rheumatologic diseases requiring acute inpatient care suffering from exacerbated pain and/or functional impairment. A rheumatologist directs the treatment program including multimodal assessments and treatment from three of the following: ergotherapy, physiotherapy, pain medicine and cognitive behavioural treatment. Objective(s): To evaluate the effectiveness of a one-week inpatient MRCT on musculoskeletal pain and function of patients with rheumatologic disorders. Method(s): 59 consecutive patients were entered into a program of multimodal treatment courses from January 2021 until December 2021. Two patients were excluded for evaluation (one patient acquired COVID-19 during hospitalization and one patient was excluded due to missing data). Pain was assessed via visual analogue scale (VAS) and functional impairment via the "Funktionsfragebogen Hanover (FFbH)" and the "Health Assessment Questionnaire (HAQ)" at admission, at discharge and at 12 weeks of follow up. Paired t-test analyses for all treatment episodes were performed. Result(s): The mean treatment duration (days, +/-SD) was 8.1 +/- 0.8. Mean age (years, +/-SD) of the 57 patients treated in the MRCT program was 57.2 +/- 12.5, with 72% female and 28% male patients. Of all patients, 40% had an underlying inflammatory disorder, 60% a non - inflammatory rheumatic disease. 23% of all patients had "back pain", 14% "spondyloarthritis" and 11% "rheumatoid arthritis". VAS (pain) mean at admission was 6.9 +/- 1.0 (SD), HAQ mean 0.57 +/- 0.23 (SD) and FFbH mean 81.44 +/- 7.95 (SD), respectively. Significant improvements in VAS, HAQ and FFbH were demonstrated at discharge, with a mean improvement of VAS of -2.86 (95% CI: -3.07 to -2.64, P value: <0.0001), a mean improvement of HAQ of -0.24 (95% CI: -0.28 to -0.20, P value: <0.0001) and a mean improvement of FFbH of 5.38 (95% CI: 3.78 to 6.98, P value: <0.0001). Follow up assessment at week 12 was recorded in 22 patients (39%) with a significant mean improvement in VAS of -2.23 (95% CI: -2.98 to - 1.48), P value <0.0001). Conclusion(s): Significant improvement of pain and function was demonstrated at discharge and at week 12 in patients with rheumatologic diseases and musculoskeletal pain completing a one-week inpatient multimodal interprofessional treatment program. A multimodal therapeutic approach may provide an effective treatment strategy superior to unimodal standard management.
ABSTRACT
Objectives: Routine monitoring of vaccine-induced anti-S responses following mRNA based SARS-CoV-2 vaccination is not recommended routinely as uncertainties exist about the critical threshold of antibody levels that correlate to protection and the optimal timepoint for determination. In our study, anti-S antibody were analysed over 24 weeks following a standard two-dose regimen of mRNA based anti-SARS-CoV-2 vaccines and correlated to the development and persistence of neutralizing activity against SARSCoV- 2 in patients with rheumatoid arthritis (RA) on DMARD therapy compared to healthy controls (HC). Method(s): The RECOVER study was a prospective, controlled, monocentric study. Assessments were performed before vaccination, and at three, six, 12 and 24 weeks after the first vaccine dose. Result(s): In RA patients, anti-S responses developed slower and resulted in lower peak titers compared to HC. A potent neutralizing activity (NT50) as assessed by a SARS-CoV-2 pseudoneutralization assay was observed in 60.3 % of all 73 RA patients and in all 21 HC after 12 weeks. A significant correlation between peak anti-S levels two weeks after the second vaccine dose and the development of a persistent neutralizing activity against SARS-CoV-2 was observed at week 12 and week 24. The analysis of IgG, IgA, and IgM isotype responses to RBD, S1, S2, and N proteins revealed a delayed IgG response, while IgA and IgM responses were maintained, suggesting a delayed isotype switch in RA patients. Conclusion(s): Peak anti-S IgG levels two weeks after the second vaccine dose significantly predicted the development and persistence of a potent neutralizing activity against SARS-CoV-2 after 12 and 24 weeks. Our data suggest that the early determination of anti- S levels allows the timely identification of non- or poor-responding patients.