Group therapy in a cohort study of Egyptian patients with rheumatoid arthritis.

INTRODUCTION: Rheumatoid arthritis (RA) affects many individuals' issues beyond those which are medically treated. OBJECTIVE: To study the impact of group therapy sessions on disease activity and functional abilities in RA patients. METHODS: One hundred and two patients with RA were divided into two groups; group A included 52 RA patients receiving their regular medical care in addition to group therapy sessions (cases); and group B included 50 RA patients receiving their regular medical care only (controls). Demographic, clinical and serological data were prospectively evaluated. All patients were assessed by using the Disease Activity Score of 28 joints (DAS28) and modified Health Assessment Questionnaire - Disability Index (mHAQ-DI), Hospital Anxiety and Depression scale (HAD) before, during and after group therapy sessions. RESULTS: Group A showed a statistically significant improvement in DAS28 at the 3rd and 6th months (P < 0.01 and P < 0.04) respectively, significant improvement in mHAQ score at the 3rd and 6th months (P < 0.02 and P < 0.00) respectively, and significant improvement in HAD scale for depression and anxiety (P <0.001). In group A there was no significant correlation between DAS28 and both anxiety or depression (P = 0.6, r = 0.5 and P = 0.06, r = 0.06) respectively, but on correlating mHAQ to both anxiety and depression, there was a statistically significant positive correlation at 6 months (P = 0.01, r = 0.3 and P = 0.03, r = 0.3) respectively. CONCLUSION: Group therapy sessions improve disease outcome, functional disability and psychological well-being in RA patients.

Three years experience with the prescription of anti-TNF-alpha inhibitors at Dr Soliman Fakeeh Hospital in Jeddah, Saudi Arabia.

OBJECTIVE: To document the difficulties that are associated with the prescription of anti-TNF inhibitors due to their high cost for patients with various autoimmune rheumatic diseases in the Kingdom of Saudi Arabia. METHODS: Patients who had been prescribed anti-TNF inhibitors for the treatment of autoimmune rheumatic diseases at Dr. Soliman Fakeeh Hospital in the Kingdom of Saudi Arabia from 2005 to July 2008 were retrospectively included in this study. Data collected included patients' demographics, funding methods, treatment doses and assessment results. RESULTS: Thirty-six patients were included in this study. Seventy percent of these were covered by various insurance packages while 30% were paying cash for their treatment. Of those 36 patients, seven dropped out within the first 2 months of treatment. Thereafter, a gradually increasing number of patients either discontinued treatment or were no longer compliant with their scheduled injection dates. There was a statistically highly significant correlation between financial difficulties and discontinuing treatment and/or spacing-out the administration of anti-TNF agents (P < 0.001). On the other hand, neither safety nor efficacy profiles were shown to significantly impact drug discontinuation. The impact of financial difficulties tended to be more prominent during the first 6 months of treatment. CONCLUSION: Financial issues appear to be the major factor that is interfering with the compliance with treatment with anti-TNF agents in the Kingdom of Saudi Arabia. The anti-TNF agents studied were generally well tolerated and were effective.