Rheumatoid arthritis (RA) is the most common inflammatory polyarthritis and a major health problem. Although medical interventions are being used much earlier in the course of RA, these interventions do not address the challenges of coping with the early stages of this disease. To date, only one, very recent study has evaluated the efficacy of coping skills training (CST) during the early course of RA. Although its findings suggest CST may be helpful, the study had methodological limitations (e.g. lack of control for attention, relatively short-term follow-up). It also used a traditional CST intervention that did not specifically address the unique challenges posed by the early course of RA. The proposed study seeks to determine whether a comprehensive coping skills training intervention can improve pain, psychological disability, and physical disability in patients with early RA. 225 patients with early RA will be assigned to 1 of 3 conditions: 1) Comprehensive Coping Skills Training, 2) Arthritis Education, or 3) Standard Care. Patients in the comprehensive coping skills training condition will receive training in a variety of cognitive and behavioral coping strategies and training in specific techniques for improving communication, setting short- and long-term goals, and enhancing maintenance. Patients in the arthritis education condition will attend sessions providing them with detailed information on rheumatoid arthritis and its treatment. Patients in the standard care condition will continue to receive the standard medical care provided to RA patients. Measures of pain, physical disability, and psychological disability and traditional clinical outcome measures will be collected pre- and post- treatment and at 6, 12, and 18 months follow-up. A self-efficacy scale and daily measures of coping, life events, mood, and pain will be gathered at each evaluation in order to analyze how these variables relate to long-term outcome. If comprehensive CST is effective, it could lead to new research and a greater integration of CST methods into the medical management of early RA. Future studies could examine whether comprehensive CST alters the long-term disease course of persons with RA. Finally, future studies could examine whether comprehensive CST alters the immune responses of RA patients to daily stressors.
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