Objectives A pilot study to assess the effect of increased air pressure in a hyperbaric chamber on patients with active rheumatoid arthritis.
Methods Seven out-patients with active rheumatoid arthritis (RA) and taking at least one disease modifying anti-rheumatic drug (DMARD) entered a hyperbaric chamber for 30 min. Patients were randomised to control and test groups and assessed in a double-blind fashion. The test group had the atmospheric pressure increased to 2 atmospheres. The control group did not have the pressure altered. Active disease was defined as a pain score on a 100 mm visual analogue scale (VAS) greater than 60 mm and 3 out of 4 from the following: – ESR >28 mm/hr, >6 swollen joints, >6 tender joints and early morning stiffness >45 min. The following were recorded or measured: pain score (by 100 mm VAS), number of swollen joints, number of tender joints, patients global score on a 100 mm VAS, ESR and CRP. The above measurements were repeated 30 min after leaving the hyperbaric chamber, the following day and 7 days later. Disease Activity Scores (DAS) were calculated using the DAS 28.
Results Four female and three male patients participated. Mean age was 58.4 years (range:41–71 yrs), mean disease duration 10.86 yrs (4–20 yrs). In the test group the pain score of 1 patient was reduced by 60% and DAS by 38% at 24 hrs but had returned to the pre-test values by 7 days. Pain scores from the other 2 patients did not alter. In the control group the pain scores of 2 patients had fallen by 60% and 64% and at 30 mins post-test. This effect was maintained to 7 days for the latter patient whose DAS fell by 54% and at 24 hrs for the former patient whose DAS did not change, however, this patient’s oral steroid dose was inadvertently altered between the 24 hr and 7 day assessment. All patients in the test group had reduced swollen joint counts at 30 mins and 24 hrs post-test, this was maintained at 7 days in 2 patients; the tender joint count was reduced in 1 patient at 24 hrs only. 3 out of the 4 control patients had reduced swollen joint counts from 30 mins post-test this was maintained at 24 hrs and 7 days, the same patients also had reduced tender joint counts. There was no change in the ESRs in either group. The CRP in 1 patient from the test group fell at 24 hrs and further decreased at 7 days. In the control group CRP decrease in 1 patient at 24 hrs only, neither of these 2 patients had reduced pain scores or DAS during the study.
Conclusion In the small number of patients studied, increased atmospheric pressure does not appear to have any effect on active rheumatoid arthritis. There also appears to be a large placebo response.
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