Touching relief: A complementary path to easing rheumatoid arthritis pain

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent synovial inflammation, leading to pain, joint stiffness, and functional impairment. Despite advances in pharmacological treatments, including disease-modifying antirheumatic drugs (DMARDs) and biologic agents, many patients continue to experience residual symptoms that negatively affect quality of life. This review aims to evaluate the potential role of massage therapy as a complementary approach in the management of RA, with a focus on its clinical effects and proposed mechanisms. A structured literature search was conducted in Medline/PubMed, Scopus, and the Directory of Open Access Journals (DOAJ) for studies published up to March 1, 2025. Studies were considered if they included individuals diagnosed with RA, evaluated any form of massage therapy (e.g., Swedish massage, aromatherapy massage, reflexology), and reported clinical or patient-reported outcomes. Both randomized controlled trials and quasi-experimental studies were included, while studies involving non-RA populations or insufficient methodological detail were excluded. However, this review was not designed as a fully systematic review and may be subject to selection bias. The available evidence suggests that massage therapy may be associated with improvements in pain, joint mobility, and patient-reported outcomes in individuals with RA. However, the overall strength of evidence is limited by methodological concerns, including small sample sizes, heterogeneity in intervention protocols, and the frequent lack of appropriate control groups. While some studies report reductions in inflammatory biomarkers such as interleukin-6 (IL-6) and C-reactive protein (CRP), these findings are based on limited evidence and should be interpreted cautiously, particularly in studies where massage therapy is combined with other interventions. Massage therapy may also contribute to psychological well-being by reducing stress and improving overall mental health. Evidence derived from non-RA populations was considered only as supportive background and was not central to the conclusions of this review. Additionally, the potential for publication bias should be acknowledged, as studies with positive findings are more likely to be published. The integration of massage therapy into RA management may benefit from nurse-led approaches; however, variability in practitioner training and the lack of standardized intervention protocols remain important challenges. Future research should prioritize well-designed, adequately powered randomized controlled trials focusing specifically on RA populations, with standardized massage interventions and clearly defined outcome measures.

Keywords

• Complementary therapies
• massage therapy
• nursıng care
• rheumatoid arthritis

References

1. Di Matteo A, Bathon JM, Emery P (2023) Rheumatoid arthritis. Lancet 402(10416):2019–2033. https://doi.org/10.1016/S0140-6736(23)01525-8
2. Almutairi K, Nossent J, Preen D, Keen H, Inderjeeth C (2021) The global prevalence of rheumatoid arthritis: a meta-analysis based on a systematic review. Rheumatol Int 41(5):863–877. https://doi.org/10.1007/s00296-020-04731-0
3. Chancay MG, Guendsechadze SN, Blanco I (2019) Types of pain and their psychosocial impact in women with rheumatoid arthritis. Womens Midlife Healt 5:3. https://doi.org/10.1186/s40695-019-0047-4
4. Küçükdeveci AA (2019) Nonpharmacological treatment in established rheumatoid arthritis. Best Pract Res Clin Rheumatol 33(5):101482. https://doi.org/10.1016/j.berh.2019.101482
5. Fedorchenko Y, Mahmudov K, Abenov Z, Zimba O, Yessirkepov M (2024) Rehabilitation of patients with inflammatory rheumatic diseases and comorbidities: unmet needs. Rheumatol Int 44(4):583–591. https://doi.org/10.1007/s00296-023-05529-6
6. Rose G (2006) Why do patients with rheumatoid arthritis use complementary therapies? Musculoskelet Care 4(2):101–115. https://doi.org/10.1002/msc.82
7. Kocyigit BF, Sagtaganov Z, Yessirkepov M, Akyol A (2023) Assessment of complementary and alternative medicine methods in the management of ankylosing spondylitis, rheumatoid arthritis, and fibromyalgia syndrome. Rheumatol Int 43(4):617–625. https://doi.org/10.1007/s00296-022-05267-1
8. Buchanan WW, Rainsford KD, Kean CA, Kean WF (2024) Treatment of rheumatic musculoskeletal disorders. Inflammopharmacology 32(1):29–36. https://doi.org/10.1007/s10787-023-01312-y

9. Grainger R, Walker J (2014) Rheumatologists’ opinions towards complementary and alternative medicine: a systematic review. Clin Rheumatol 33(1):3–9. https://doi.org/10.1007/s10067-013-2379-z
10. Field T, Diego M, Solien-Wolfe L (2014) Massage therapy plus topical analgesic is more effective than massage alone for hand arthritis pain. J Bodyw Mov Ther 18(3):322–325. https://doi.org/10.1016/j.jbmt.2013.12.002
11. Zhang P, Li J, Han Y, Yu XW, Qin L (2010) Traditional Chinese medicine in the treatment of rheumatoid arthritis: a general review. Rheumatol Int 30(6):713–718. https://doi.org/10.1007/s00296-010-1370-0
12. van Wissen M, Gademan M, Vliet Vlieland T, Straathof B, Teuwen M, Peter WF et al (2023) Physical therapy in patients with rheumatoid arthritis and axial spondyloarthritis: the patients’ perspective. Scand J Rheumatol 52(6):609–618. https://doi.org/10.1080/03009742.2023.2195726
13. Mori H, Ohsawa H, Tanaka TH, Taniwaki E, Leisman G, Nishijo K (2004) Effect of massage on blood flow and muscle fatigue following isometric lumbar exercise. Med Sci Monit 10(5):CR173–CR178
14. Guo J, Li L, Gong Y, Zhu R, Xu J, Zou J, Chen X (2017) Massage alleviates delayed onset muscle soreness after strenuous exercise: A systematic review and meta-analysis. Front Physiol 8:747. https://doi.org/10.3389/fphys.2017.00747
15. Wu Q, Zhao J, Guo W (2022) Efficacy of massage therapy in improving outcomes in knee osteoarthritis: A systematic review and meta-analysis. Complement Ther Clin Pract 46:101522. https://doi.org/10.1016/j.ctcp.2021.101522
16. Perlman A, Fogerite SG, Glass O et al (2019) Efficacy and safety of massage for osteoarthritis of the knee: A randomized clinical trial. J Gen Intern Med 34(3):379–386. https://doi.org/10.1007/s11606-018-4763-5
17. Field T, Diego M, Gonzalez G, Funk CG (2015) Knee arthritis pain is reduced and range of motion is increased following moderate pressure massage therapy. Complement Ther Clin Pract 21(4):233–237. https://doi.org/10.1016/j.ctcp.2015.08.002
18. Chunco R (2011) The effects of massage on pain, stiffness, and fatigue levels associated with ankylosing spondylitis: A case study. Int J Ther Massage Bodyw 4(1):12–17
19. Field T (2014) Massage therapy research review. Complement Ther Clin Pract 20(4):224–229. https://doi.org/10.1016/j.ctcp.2014.07.002
20. Bervoets DC, Luijsterburg PA, Alessie JJ, Buijs MJ, Verhagen AP (2015) Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review. J Physiother 61(3):106–116. https://doi.org/10.1016/j.jphys.2015.05.018
21. Nemati D, Hinrichs R, Johnson A, Lauche R, Munk N (2024) Massage therapy as a Self-Management strategy for musculoskeletal pain and chronic conditions: A systematic review of feasibility and scope. J Integr Complement Med 30(4):319–335. https://doi.org/10.1089/jicm.2023.0271
22. Sahraei F, Rahemi Z, Sadat Z, Zamani B, Ajorpaz NM, Afshar M, Mianehsaz E (2022) The effect of Swedish massage on pain in rheumatoid arthritis patients: A randomized controlled trial. Complement Ther Clin Pract 46:101524. https://doi.org/10.1016/j.ctcp.2021.101524
23. Kocyigit BF (2022) Can manual therapy and massage be used as complementary methods for female infertility in different age groups? Anti Aging East Eur 1(2):118–122. https://doi.org/10.56543/aaeeu.2022.1.2.06
24. Koçyiğit BF, Akyol A, Usgu S (2021) Role of manual therapy and massage in the treatment of fibromyalgia: testing the hypothesis. Cent Asian J Med Hypotheses Ethics 2(4):182–189. https://doi.org/10.47316/cajmhe.2021.2.4.01
25. Kocyigit BF, Fedorchenko Y, Sultanbekov K, Ozturk GY, Yessirkepov M (2024) Exploring complex links: inflammatory rheumatic diseases and Men’s health. Rheumatol Int 44(5):757–764. https://doi.org/10.1007/s00296-024-05549-w
26. Gasparyan AY, Ayvazyan L, Blackmore H, Kitas GD (2011) Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors. Rheumatol Int 31(11):1409–1417. https://doi.org/10.1007/s00428-011-0993-1
27. Nelson NL, Churilla JR (2017) Massage therapy for pain and function in patients with arthritis: A systematic review of randomized controlled trials. Am J Phys Med Rehabil 96(9):665–672. https://doi.org/10.1097/PHM.0000000000000712
28. SevgiÜnal Aslan K, Çetinkaya F (2023) The effects of Reiki and hand massage on pain and fatigue in patients with rheumatoid arthritis. Explore (NY) 19(2):251–255. https://doi.org/10.1016/j.explore.2022.06.006
29. Field T, Diego M, Delgado J, Garcia D, Funk CG (2013) Rheumatoid arthritis in upper limbs benefits from moderate pressure massage therapy. Complement Ther Clin Pract 19(2):101–103. https://doi.org/10.1016/j.ctcp.2012.12.001
30. Bakir E, Baglama SS, Gursoy S (2018) The effects of reflexology on pain and sleep deprivation in patients with rheumatoid arthritis: A randomized controlled trial. Complement Ther Clin Pract 31:315–319. https://doi.org/10.1016/j.ctcp.2018.02.017
31. Cai DC, Chen CY, Lo TY (2022) Foot reflexology: recent research trends and prospects. Healthc (Basel) 11(1):9. https://doi.org/10.3390/healthcare11010009
32. Hekmatpou D, Mortaji S, Rezaei M, Shaikhi M (2020) The effectiveness of Olive oil in controlling morning inflammatory pain of phalanges and knees among women with rheumatoid arthritis: A randomized clinical trial. Rehabil Nurs 45(2):106–113. https://doi.org/10.1097/rnj.0000000000000162
33. Brennan SE, McDonald S, Murano M et al (2022) Effectiveness of aromatherapy for prevention or treatment of disease, medical or preclinical conditions, and injury: protocol for a systematic review and meta-analysis. Syst Rev 11:148. https://doi.org/10.1186/s13643-022-02015-1
34. Barão Paixão VL, Freire de Carvalho J (2021) Essential oil therapy in rheumatic diseases: A systematic review. Complement Ther Clin Pract 43:101391. https://doi.org/10.1016/j.ctcp.2021.101391
35. Gok Metin Z, Ozdemir L (2016) The effects of aromatherapy massage and reflexology on pain and fatigue in patients with rheumatoid arthritis: A randomized controlled trial. Pain Manag Nurs 17(2):140–149. https://doi.org/10.1016/j.pmn.2016.01.004
36. Bahr T, Allred K, Martinez D, Rodriguez D, Winterton P (2018) Effects of a massage-like essential oil application procedure using Copaiba and deep blue oils in individuals with hand arthritis. Complement Ther Clin Pract 33:170–176. https://doi.org/10.1016/j.ctcp.2018.10.004
37. Pantovic SM, Roganovic MB, Slavic VG, Zvizdojevic JM (2024) Laboratory features of effects of peloidotherapy and aromatherapy in patients with rheumatoid arthritis. Int J Biometeorol 68(5):855–860. https://doi.org/10.1007/s00484-024-02630-8
38. Varkaneh ZK, Karampourian A, Oshvandi K, Basiri Z, Mohammadi Y (2022) The effect of eucalyptus inhalation on pain and the quality of life in rheumatoid arthritis. Contemp Clin Trials Commun 29:100976. https://doi.org/10.1016/j.conctc.2022.100976
39. Diego MA, Field T (2009) Moderate pressure massage elicits a parasympathetic nervous system response. Int J Neurosci 119:630–638. https://doi.org/10.1080/00207450802329605
40. Bennett S, Bennett MJ, Chatchawan U, Jenjaiwit P, Pantumethakul R, Kunhasura S, Eungpinichpong W (2016) Acute effects of traditional Thai massage on cortisol levels, arterial blood pressure and stress perception in academic stress condition: A single blind randomised controlled trial. J Bodyw Mov Ther 20:286–292. https://doi.org/10.1016/j.jbmt.2015.10.005
41. Crane JD, Ogborn DI, Cupido C, Melov S, Hubbard A, Bourgeois JM, Tarnopolsky MA (2012) Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Sci Transl Med 4:119ra13. https://doi.org/10.1126/scitranslmed.3002882
42. Morhenn V, Beavin LE, Zak PJ (2012) Massage increases Oxytocin and reduces adrenocorticotropin hormone in humans. Altern Ther Health Med 18:11–18
43. Rapaport MH, Schettler P, Bresee C (2012) A preliminary study of the effects of repeated massage on hypothalamic-pituitary-adrenal and immune function in healthy individuals: A study of mechanisms of action and dosage. J Altern Complement Med 18:789–797. https://doi.org/10.1089/acm.2011.0071
44. White GE, West SL, Caterini JE, Di Battista AP, Rhind SG, Wells GD (2020) Massage therapy modulates inflammatory mediators following sprint exercise in healthy male athletes. J Funct Morphol Kinesiol 5:9. https://doi.org/10.3390/jfmk5010009
45. Stenbäck V, Lehtonen I, Mäkelä KA, Raza GS, Ylinen V, Valtonen R, Hamari T, Walkowiak J, Tulppo M, Herzig KH (2024) Effect of single session of Swedish massage on Circulating levels of interleukin-6 and insulin-like growth factor 1. Int J Mol Sci 25:9135. https://doi.org/10.3390/ijms25179135
46. Anloague A, Mahoney A, Ogunbekun O et al (2020) Mechanical stimulation of human dermal fibroblasts regulates pro-inflammatory cytokines: potential insight into soft tissue manual therapies. BMC Res Notes 13:400. https://doi.org/10.1186/s13104-020-05249-1
47. Dougados M, Soubrier M, Perrodeau E, Gossec L, Fayet F, Gilson M (2015) Impact of a nurse-led programme on comorbidity management and impact of a patient self-assessment of disease activity on the management of rheumatoid arthritis: results of a prospective, multicentre, randomised, controlled trial (COMEDRA). Ann Rheum Dis 74(9):1725–1733. https://doi.org/10.1136/annrheumdis-2013-204733
48. Auyezkhankyzy D, Khojakulova U, Yessirkepov M, Qumar AB, Zimba O, Kocyigit BF, Akaltun MS (2024) Nurses’ roles, interventions, and implications for management of rheumatic diseases. Rheumatol Int 44(6):975–983. https://doi.org/10.1007/s00296-024-05603-7
49. Yang L, Xiang P, Pi G, Wen T, Liu L, Liu D (2025) Effectiveness of nurse-led care in patients with rheumatoid arthritis: a systematic review and meta-analysis. BMJ Open Qual 14(1):e003037. https://doi.org/10.1136/bmjoq-2024-003037
50. Lopatina E, Marshall DA, Le Clercq SA et al (2021) Nurse-led care for stable patients with rheumatoid arthritis: quality of care in routine practice compared to the traditional rheumatologist-led model. Rheumatol Ther 8(3):1263–1285. https://doi.org/10.1007/s40744-021-00339-3
51. Mitzel-Wilkinson A (2000) Massage therapy as a nursing practice. Holist Nurs Pract 14(2):48–56. https://doi.org/10.1097/00004650-200001000-00009
52. Da Rocha Rodrigues G, Anex A, Boegli M et al (2023) Is massage a legitimate part of nursing care? A qualitative study. PLoS ONE 18(2):e0281078. https://doi.org/10.1371/journal.pone.0281078
53. Gholitabar Omrani M, Ghasemi Mohammad, Gholizadeh Gerdrodbari M, Javan R, Mahdavifar N (2024) The effects of foot reflexology massage on the sleep quality of nurses working in the selected hospitals of Sabzevar university of medical sciences. Trad Integr Med 9:371–378
54. Kennedy AB, Cambron JA, Dexheimer JM, Trilk JL, Saunders RP (2018) Advancing health promotion through massage therapy practice: A cross-sectional survey study. Prev Med Rep 11:49–55. https://doi.org/10.1016/j.pmedr.2018.05.001.