Clinical Disease Activity and Power Doppler Changes Observed During a Multimodal Rehabilitation Program in Rheumatoid...

Background/Objectives: Rehabilitation in active rheumatoid arthritis (RA) remains challenging, particularly regarding the dosing of physical agent modalities during inflammatory activity. We evaluated changes in clinical disease activity, inflammatory markers, and Power Doppler (PD) activity in patients with RA undergoing individualized multimodal rehabilitation. Methods: In this retrospective longitudinal study, 29 patients with RA were assessed at baseline and after 8 weeks. The program comprised 10 supervised sessions of individualized electrotherapy and therapeutic exercise over 2 weeks, followed by 6 weeks of home-based exercise. Background disease-modifying antirheumatic therapy was unchanged; 16 patients received ESR-guided methylprednisolone. Outcomes included DAS28-ESR and its components, C-reactive protein (CRP), and patient-level PD grade across a standardized joint set. Results: DAS28-ESR decreased from 6.05 ± 0.87 to 4.03 ± 0.82, with significant reductions in all its components and in CRP (all p < 0.001). Patient-level PD grade showed a significant shift toward lower grades, from a median of 2 [IQR 2-3] at baseline to 2 [IQR 1-2] at 8 weeks (p < 0.001); 18 patients (62.1%) improved, and none worsened. Changes in DAS28-ESR and PD grade were not significantly correlated (ρ = 0.181, p = 0.348). In the 13 patients who did not receive additional glucocorticoids, DAS28-ESR decreased from 5.22 to 3.41 (p < 0.001), while median PD grade changed from 2 [IQR 2-3] to 2 [IQR 2-2] (p = 0.016). Conclusions: Improvements across clinical, laboratory, and ultrasound domains were observed during individualized rehabilitation delivered alongside pharmacological treatment, while the magnitude of clinical and ultrasound changes was not significantly correlated. Because of the absence of a control group, concomitant glucocorticoid and NSAID therapy, and the possibility of regression to the mean, the contribution of rehabilitation cannot be isolated from pharmacological treatment, natural disease course, and other sources of change. Controlled studies of dose-adapted rehabilitation in active RA, prescribed by the rehabilitation physician in collaboration with the rheumatologist, are warranted.