Background/Purpose: Quality standards recommend an annual review by a multidisciplinary team (MDT) for all patients with rheumatoid arthritis (RA); however, this is based on expert opinion.

Methods: Single centre randomised single-blind controlled trial of MDT vs. routine rheumatologist review in established RA.

Primary outcome: Minimal clinically important difference (MCID) in quality of life (QOL) (increase in European QOL-5-Dimension-3-Level Singapore (EQ5D-SG) index by 0.1) at 6 months.

Secondary outcomes: Change in EQ5D-SG, pain, disease activity score in 28 joints (DAS28), physical function (modified Health Assessment Questionnaire, mHAQ), coping, self-efficacy (Rheumatoid Arthritis Self-Efficacy scale, RASE), Medication Adherence Report Scale (MARS), Disease Specific Knowledge (DSK) and physical activity.

Adult patients with RA were randomly assigned to a single visit to a 6-member MDT (rheumatologist, nurse, medical social worker, physiotherapist, occupational therapist and podiatrist) or usual care. MDT providers prescribed disease modifying anti-rheumatic drugs (DMARD) and counselled patients with respect to managing flares, medication adherence, coping, joint protection, exercise, footwear. Data were collected by face-to-face questionnaires, review of medical records and joint counts by a standardised blinded assessor at 0, 3 and 6 months. Paired and between-group t test with Bonferroni-Holm correction for multiple testing and logistic regression were used.

Results: 140 (power 95%, 10% attrition) patients (86.3% female, 53.4% Chinese, age 54.4±12.7 years) were recruited. There were fewer females and seropositive patients in MDT (Table 1). The median (IQR) disease duration was 5.5 (2.4, 11.0) years and DAS28 was 2.87 (2.08, 3.66). There was more DMARD escalation in MDT (34.4% vs. 19.4%), and the mean patient experience score (1-10) was higher (8.9±1.0 vs. 8.4±1.0, p=0.009).

123 patients completed the study. 40.6% (MDT) vs. 34.3% patients achieved an MCID in EQ5D-SG, OR 1.3 (0.6, 2.7). Among the secondary outcomes, there were significant within group improvements in RASE and coping in the MDT arm, but not in the control arm (Table 2).

Conclusion: A single visit to a MDT in stable patients with established RA and low disease activity failed to achieve a MCID in EQ5D-SG index but did achieve small but significant improvements in coping and self-efficacy. Patients valued the MDT experience. Recommendation of MDT care needs to balance resource use with marginally improved outcomes.

Table 1: Baseline Characteristics

Table 2: Secondary outcomes

All values are mean (95% CI)

*significant after Bonferroni-Holm correction