Background/Purpose: Both RA and PsA patients carry significant morbidity despite advances in treatment. Patients often do not achieve clinical remission which can be limited by patient’s global assessment of disease (PtGA). Currently utilized disease activity and functional status assessments do not address all treatment outcomes that are important to patients (such as fatigue, psychological distress and quality of life). These outcomes drive PtGA and represent important areas of focus to achieve remission in RA and PsA patients. The Patient Reported Outcome Measurement Information System (PROMIS®) developed by the National Institute of Health, is a set of patient centric measures evaluating physical, mental and social health and is a precise and reliable way to measure domains critical to PtGA.

Functional medicine utilizes a patient-centered approach, addressing sleep, exercise, nutrition, stress and other lifestyle factors. The desire for this approach has led more patients to turn to functional medicine for adjunctive care.

Methods: In this 12 week retrospective study, RA and PsA patients were identified by ICD 10 code. They were included if they were diagnosed by a board certified rheumatologist and participated in a 12 week functional medicine program adjunctive to their usual care. PROMIS global physical and mental health and pain scores were collected at baseline and after 12 weeks of enrollment and compared to patients with similar baseline characteristics who received usual care alone. Changes in PROMIS T score domains in global physical, global mental health and pain were compared between treatment groups using two-sample t-tests.

Results: 38 patients were identified for inclusion. Both functional medicine + usual care (n=19) and usual care alone (n=19) had similar baseline characteristics including age, gender, smoking status and seropositivity. Baseline global physical and mental health scores were similar, however, pain was significantly lower at baseline in the functional medicine group as compared to the usual care group. At 12 weeks, there was no statistically significant difference between groups in any primary outcome, however there was a trend towards improved physical health scores and pain in the functional medicine group at 12 weeks (Table 1).

Table 1: Change in primary outcome scores from baseline to week 12

Conclusion: Enrollment in an adjunctive functional medicine program did not demonstrate a statistically significant improvement in pain, functional or mental health scores after 12 weeks but did show trends toward improvement in pain and physical function. Larger, prospective studies of longer duration are needed to identify the subset of patients who would benefit from a functional medicine intervention.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/what-is-the-impact-of-functional-medicine-on-patient-reported-outcomes-in-inflammatory-arthritis/