Benefits of Hospitalization in Rheumatoid Arthritis

A study is reported comparing the effects of in-patient hospital treatment with out-patient management in 30 patients with active rheumatoid arthritis. Sixteen patients were admitted to hospital and received a modified bed-rest regime with at least 13 hours bed-rest daily and 14 were treated on an out-patient basis. All received the same oral medication of indomethacin 100 mg daily, and assessment of progress was made at weekly intervals for four weeks. The out-patient group showed no significant improvement at the end of the four-week period, whereas in the hospitalized patients significant improvement was observed in pain severity, duration and severity of morning stiffness, articular index of joint tenderness and grip strength. However, the improvement in this group, as a whole, was not dramatic and approximately half the patients showed no substantial change. The benefits of hospital in-patient treatment in active rheumatoid arthritis are probably not as great as most physicians would expect, but are still, in our opinion, sufficient to justify admission to hospital for those patients who have failed to respond to a reasonable period of out-patient treatment, before commencing more potent anti-rheumatic therapy seen as corticosteroids. The result of the study also has implications in the design of protocols for clinical trials of anti-rheumatic drugs where hospital in-patients are used.