Comprehensive Outpatient Care in Rheumatoid Arthritis

Patients with classical or definite rheumatoid arthritis by American Rheumatism Association (ARA) criteria (peripheral type, functional classes 2 and 3 and anatomical stages 2 and 4), were randomly assigned to treatment and control groups in a study of effectiveness of multidisciplinary clinic and home care. Comprehensive care was supplied by staff of the Arthritis Outpatient Clinic of University Hospitals of Cleveland and by staff of the Visiting Nurse Association of Cleveland. Services were coordinated through regularly held staff conferences. An independent clinical investigation team evaluated changes in function and disease activity. Treatment was beneficial in the following terms: fewer deteriorations in activities of daily living, more numerous improvements and fewer deteriorations in economic dependence, and more improvements and fewer deteriorations in clinical manifestations of disease activity. Of methodologic importance was the demonstration of the feasibility of controlled testing of long-term program effectiveness.