Sarcouncil Journal of Internal Medicine and Public Health

Abstract: Patients with rheumatoid arthritis (RA) have anemia of chronic disease, which is a contributing factor to fatigue, low functional capacity, and reduced quality of life. The proposed study is a randomized controlled trial that undertakes the assessment of the effect of multidisciplinary rehabilitation intervention on anemia and disease activity among RA patients. A cross-sectional study was carried out with 111 patients with anemia who had existed in a longitudinal cohort with RA and received a multidisciplinary rehabilitation program. Baseline variables were a mean age of 58.4 years, 76.6 per cent of which is females, and a mean disease duration of approximately 9.8 years. The number of patients with anemia was mild (60.4%), moderate (35.1%), and severe (4.5%). The hematologic parameters (hemoglobin, hematocrit, MCV, ferritin, and soluble transferrin receptor), inflammatory parameters (CRP), and disease activity (DAS28-CRP) were measured at baseline and 6 months. The FACIT-Fatigue scale, as well as HAQ-DI, were patient-reported outcomes. Data on pharmacologic management (DMARDs, corticosteroids, iron supplementation, and ESA) were taken. After 12 months of follow-up, hemoglobin increased 10.5 g/dL to 12.1 g/dL with DAS28-CRP lowered to 2.9g/dL, which showed improvement in anemia and disease activity. Hematocrit improved from 32.1 to 36.8%, MCV improved from 85.2 to 87.1 fL, ferritin improved from 98.5 to 112.4 ng/mL, and sTfR improved from 3.8 to 3.1 ml/L. 36.9% of patients showed improvement, 37.1 to 38.8; 52.3 to 54.7 ml/L; 98.5 to 112.4 ng/mL; and The percentage receiving DAS28-CRP remission/low disease activity improved significantly and the remission percentage rose during 4.5 to 28.8 and low disease activity between 10.8 and 40.5. The score on FACIT-Fatigue marginally changed (mean change +13.6), with the different values being 22.5 to 36.1, which showed less fatigue. The scores of HAQ-DI improved by 14.5 to 0.92, and this means that the functional status has improved (mean change -0.53). Correlations were established to be strong and negative between Hb increase and CRP (r = -0.72, p < 0.001) and DAS28 improvement (r = -0.65, p < 0.001), and a positive correlation with FACIT-F improvement (r = 0.69, p < 0.001). In outcomes, positive changes in Hb were associated with the enhancement of the control of inflammatory conditions and functional recovery. RA patients with anemia receiving a multidisciplinary rehabilitation program attained significant clinical benefits in terms of normalization or improvement of hemoglobin, positive effects in reducing disease activity, and patient outcome measures of fatigue and functional status. Hb increase was directly linked to the decrease in CRP and DAS28-CRP, as well as improvements in fatigue, highlighting the quality of holistic care methods based on the combination of hematologic and rheumatologic disease management. The findings will justify the approach of multidisciplinary management as a successful strategy in enhancing anemia and general disease control in RA.