Abstract
Introduction: Rheumatoid arthritis (RA) is the most common chronic systemic autoimmune disease. Chronic and severe course, early disability, social disadaptation as well as the high incidence of psychological problems require the development of an integrated approach to etiopathogenesis, diagnostics, management as well as rehabilitation and preventive care.
Theory: We have developed a synergetic bio-psycho-socio-spiritual concept of ontogenesis that is represented by a four-dimensional model consisting of vectors of somato- and psycho-, socio- and animogenesis. Animogenesis is a term that integrates understanding of soul and spirit and represents the central fourth part of the proposed ontogenetic model. The vectors are interrelated and determine transit zones with a central part containing conscience – the highest level of self-regulation and reflection of reality accumulating spiritual-moral potential.
Results: We propose a synergetic concept for RA development with identified there prenosological stages: predisposition - arthritic family, latent - arthritic diathesis, initial - prearthritic state and three nosological stages: onset, chronic phase and outcomes. Based on the concept we have developed a multidisciplinary program of care for patients with RA, which includes four sections/blocks: medical, psychological, spiritual-moral and social. Preventive measures are implemented in the first three prenosological stages, treatment and rehabilitation - in the three nosological stages, constituting a single multidisciplinary protocol of care for RA patients. The protocol is realized by a team composed of a rheumatologist, psychotherapist, clinical psychologist, social worker and bioethics specialist.
Discussions: The model presupposes a multidisciplinary and integral approach to complex psychosomatic cause-effect relationships in the course of the disease. The proposed methodology makes it possible to formulate clinical, psychological, social and moral diagnoses resulting in a synergetic functional diagnosis.
Conclusions: Synergetic bio-psycho-socio-spiritual concept of the disease and a multidisciplinary program of care enable to establish personalized protocols for patients with RA, improve management and control the progression of the disease. Lessons learned: The developed framework for RA allows to mobilize new resources and launch effective mechanisms of therapeutic and preventive care.
Limitations: The study focuses mainly on the methodological approach and further practical evaluation of proposed program is required.
Suggestions for future research: The program of integrated care will be realized and evaluated in a large cohort of patients with RA. Based on synergetic methodology, a multidisciplinary program of care may be developed and implemented for other chronic disorders.