A tailor-made internet-based cognitive-behavioral treatment may be useful in improving psychological and physical functioning and reducing the influence of RA on the daily life of patients.

Ferwerda and colleagues conducted a multi-center, randomized controlled trial in RA patients with elevated levels of distress as evaluated by a disease-specific measure. Standard care was given to the control group (n = 71) whereas an internet-based tailored cognitive-behavioral intervention was given to test group (n = 62). A linear mixed model was utilized for performing primary analyses determining variations between the intervention and control groups in scores of psychological functioning, physical functioning, and impact of RA on daily life at pre-assessment and post-assessment, and at 3, 6, 9, and 12 months.

Results from the study indicated that the patients who received the Internet-based intervention reported a larger improvement in psychological functioning when compared with the control group. Less depressed mood (P < 0.001, d = 0.54), negative mood (P = 0.01, d = 0.38), and anxiety (P < 0.001, d = 0.48) were indicated during the course of the 1-year follow-up period.  A trend was found in physical functioning of the intervention group that indicates less fatigue than the control group (P = 0.06, d = 0.24). No effect was found on pain measures of the intervention group. The impact of RA on daily life was found to be negligible, except for the intervention group that experienced fewer role limitations due to emotional problems (P< 0.001, d = 0.53).

The study confirms that guided Internet-based cognitive-behavioral therapy appears as an encouraging development in patients with psychological distress mainly in improving psychological functioning. Further research focusing on adherence and specific intervention ingredients is desired to have a better understanding.