Background Rehabilitation of patients with rheumatoid arthritis (RA) – important medical and social problem. A complex rehabilitation program (CRP) must include different types of physiotherapy, orthoses, occupational therapy, patient education, exercises [1, 2]. Currently, the evidence for the effectiveness of early rehabilitation of patients with rheumatoid arthritis is scanty .
Objectives To evaluate the efficacy of the CRP for patients with early RA.
Methods 36 patients with early RA were included. 20 patients underwent drug therapy and the CRP (exercise program for large joints under supervision of instructor 40 min, occupational therapy 40 min, local air cryotherapy of small joints of hands, knee or ankle joints at temperature –60°C, 15 min, 10 sessions), 16 received only drug therapy (control group). Average power left and right knees extension and ankles flexion were measured with the help of EN-TreeM movement analysis. Grip strengths of the hands, joint pain on 100-mm visual analog scale (VAS), Diseases Activity Score (DAS28), Health Assessment Questionnaire (HAQ), Rheumatology Assessment Patient Index Data (RAPID3) by Multi-Dimensional HAQ (R798–NP2) were evaluated.
Results After the CRP pain on VAS decreased by 51,0% (60,4±22,4 mm vs. 29,6±17,5 mm, p<0,01), HAQ – by 33,1% (1,18±0,62 vs. 0,79±0,58, ΔHAQ=0,39±0,22, p<0,05), RAPID3 – by 46,0% (11,08±6,46 vs. 5,98±3,56, ΔRAPID3=5,10±0,45, p<0,01). Reduction of DAS28 (4,33±1,36 vs. 3,96±1,29, p>0,05) was not statistically significant. In the control group significantly decreased only pain on VAS by 30,1% (58,9±31,4 mm vs. 41,2±28,4 mm, p<0,05). After the CRP grip strength of the more affected hand enhanced by 27,4% (31,8±17,6 kPa vs. 40,5±22,3 kPa, p<0,05), of the less affected hand – by 20,0% (41,5±25,2 kPa vs. 49,8±20,8 kPa, p<0,05). Average power extension of the weaker knee joint of the patients with the damage of knee joints increased by 78,2% (3,72±2,29 W vs. 6,63±4,35 W, p<0,01), of the stronger knee joint – by 57,9% (5,85±3,21 W vs. 9,24±4,53 W, p<0,01). Average power flexion of the more affected ankle joint of the patients with the arthritis of ankle joints elevated by 68,9% (0,45±0,25 W vs. 0,76±0,37 W, p<0,01), of the less affected ankle joint – by 51,7% (0,58±0,29 W vs. 0,88±0,24 W, p<0,01). In the control group significantly increased only average power extension of the weaker knee joint by 20,9% (3,59±2,45 W vs. 4,34±2,95 W, p<0,05). At the end of the treatment, there were statistically significant differences between groups for most parameters.
Conclusions This study showed that En-TreeM movement analysis makes it possible to quantify the functional status of every lower-extremity joint group. The CRP, which includes cryotherapy, exercise therapy and occupational therapy, helps to relieve pain, improves quality of life and increases functionality and motion activity (grip strength and power of motion) of RA patients immediately after the intervention.
Vliet Vlieland T.P.M. Rehabilitation of people with rheumatoid arthritis. Best Pract Res Clin Rheumatol 2003;17(5):847–61.
Vliet Vlieland T.P.M. Non-drug therapies in early rheumatoid arthritis.Best Pract Res Clin Rheumatol 2009;23(1):103–16.
Disclosure of Interest None Declared