Background In 90% of patients with rheumatoid arthritis (RA) the joints of the hand are affected, causing impaired hand function. In general, reduced strength and range of motion of the hand are seen in patients with RA.
Studies have shown positive effect on pain and function after exercise intervention for the hand in patients with RA. However, it is unclear if the disease activity in the joints of the hand is influenzed by an exercise program.
Ultrasound imaging (US) is shown to correlate with other markers of disease activity in RA and can be used as a surrogate measure for inflammation in the joint, as US visualizes synovial hypertrophy and increased blood flow.
Objectives To investigate if intensive hand exercise combined with joint protection education for the hand in women with RA can be conducted without a negative effect on the disease activity in the wrist and metacarpal (MCP) joints.
Methods This is a sub-study of a randomised clinical trial investigating hand exercise therapy as add on to education in joint protection during activities of daily living (ADL) performance. The intervention group (IG) had both ADL education and exercise therapy and the control group (CG) had only ADL education.
The participants were women with RA involving the hand who had been on stable medication for at least three month.
At baseline all participants were examined by a rheumatologist. The joints were examined, blood samples collected and pain and strength of the hand were measured. Patient's functional ability was assessed using the Assessment of Motor and Process Skills (AMPS). US examination of the wrist and MCP 2–5 dorsal and volar in both hands was made. In the US examination both the amount of synovial hypertrophy and increased blood flow (Doppler activity) was evaluated. The evaluated was made according to a validated scoring system sum. (1)
After baseline examination the patients were randomised to either IG or CG.
The hand exercise program contained both range of motion and strengthening exercises for the finger, wrist, elbow and shoulder joints. The exercise program was conducted four times a week for eight weeks, once a week supervised by a physiotherapist, to avoid overload of the joints and to progress the exercises if possible.
After eight weeks all baseline measures were repeated and change from baseline was calculated using the per protocol approach.
Results Fifty five women with RA were included in the study (IG: 28; CG 27). Eight withdraw during the study period, six from the IG and two from the CG. Thus, 22 from the IG and 25 in the CG were included in the final analysis. The mean age 63.6 (12.6) years and mean disease duration was 12.7 (11.3) years, baseline mean tender and swollen joint were 4.8 (4.7) and 1.3 (1.7), respectively.
No differences in change from baseline in tender joint count, hand pain and strength and functional ability was seen between the two groups (data not shown).
The mean score and change from baseline in US score and inflammatory marker (CRP) in the blood are seen in table below.
Conclusions Women with RA of the hand experience no negative effect on the disease activity in the joints of the hand after eight weeks combined hand exercise and joint protection education.
Hammer HB et al. Ann Rheum Dis 2011 Nov;70(11):1995–8.
Disclosure of Interest None declared