Objective.To conduct a proof-of-concept randomized trial of an Internal Family Systems (IFS) psychotherapeutic intervention on rheumatoid arthritis (RA) disease activity and psychological status.Methods.Patients with RA were randomized to either an IFS group for 9 months (n = 39) or an education (control) group (n = 40) that received mailed materials on RA symptoms and management. The groups were evaluated every 3 months until intervention end and 1 year later. Self-assessed joint pain (RA Disease Activity Index joint score), Short Form-12 physical function score, visual analog scale for overall pain and mental health status (Beck Depression Inventory, and State Trait Anxiety Inventory) were assessed. The 28-joint Disease Activity Score-C-reactive Protein 4 was determined by rheumatologists blinded to group assignment. Treatment effects were estimated by between-group differences, and mixed model repeated measures compared trends between study arms at 9 months and 1 year after intervention end.Results.Of 79 participants randomized, 68 completed the study assessments and 82% of the IFS group completed the protocol. Posttreatment improvements favoring the IFS group occurred in overall pain [mean treatment effects −14.9 (29.1 SD); p = 0.04], and physical function [14.6 (25.3); p = 0.04]. Posttreatment improvements were sustained 1 year later in self-assessed joint pain [−0.6 (1.1); p = 0.04], self-compassion [1.8 (2.8); p = 0.01], and depressive symptoms [−3.2 (5.0); p =0.01]. There were no sustained improvements in anxiety, self-efficacy, or disease activity.Conclusion.An IFS-based intervention is feasible and acceptable to patients with RA and may complement medical management of the disease. Future efficacy trials are warranted. ClinicalTrials.gov identifier: NCT00869349.

Objectives: Describe the development and feasibility of a telephone peer support program that provides education, emotional support, and enhances coping skills among rheumatoid arthritis (RA) patients. Methods: In an academic arthritis center, peer coaches received 5 training modules: 1) definition and expectations of peer coaching, 2) structure/management of phone calls, 3) confidentiality, 4) psychological techniques for encounters, 5) referral guidelines and resources. Follow-up, acceptability and comparison with patients receiving standard care included mean adjusted change differences at 6 months in fatigue, pain, self-efficacy, functional status (SF-12), flare frequency and medication adherence (ASK-20). Results: Eighteen peer coaches were assigned on average, 1.7 (SD, 1.4) patients. They spoke 8.4 (SD, 7.2) times; 21 of 29 patients completed the program. The most common topics requested were how to manage flares, 10(48%), medical aspects of RA, 10(48%) and understanding how to live with RA, 9(43%). After 6 months, non-significant improvements occurred in study outcomes (largest changes SF-12 PCS (mean adjusted change (SE) intervention v. standard care, 4.7(2.6) v. 0.5(2.0)) and how RA impacts one’s life (1.8(6.4) v. −4.9(5.8)). Participants reported many benefits from peer support. They felt less alone, 13(62%), more part of a sharing community, 12(57%) and had a better understanding of RA, 9(43%). They felt calmer, 9(43%), less sad,5(24%) and that they had more support from family and friends, 5(24%). Conclusions: An RA telephone peer support program is feasible and acceptable to patients. While the study was underpowered to detect statistical improvements, patients reported benefits suggesting the need for randomized evaluation.