The Effect of an Intensive Hand Exercise Program on Muscle Strength and Hand Functions in Patients with Rheumatoid Arthritis

Abstract

Aim: This study investigated the effectiveness of classic and intensive exercise programs in patients with rheumatoid arthritis (RA) and their relationship with disease activity and patient functional well-being. Material and Methods: Sixty patients aged 18 to 65, diagnosed with RA in our clinic, were randomly divided into two groups of 30 each. The first group received an intensive exercise program, while the second group received a classic exercise program. Disease activity was evaluated using erythrocyte sedimentation rate, C-reactive protein, DAS28Sedim, and DAS28Crp. Daily life activities were assessed using the HAQ score and Duruöz hand index. Joint mobility measurements were taken with a goniometer, and muscle strength measurements were taken using a manual dynamometer and pinch meter. Hand and wrist radiographs were taken and evaluated according to Steinbroker stages before exercise therapy. Results: Improvement was observed in both groups' Visual Analog Scale (VAS) and Health Assessment Questionnaire (HAQ) scores, with a significant improvement in VAS scores favoring the intensive exercise group. Conclusions: The study concluded that exercise therapy had positive effects on patients' hand functions, and the intensive exercise program was more effective.

Keywords

• Rheumatoid Arthritis
• Exercise
• Disease Activity

Kaynakça

1. 1. Brasington RD. Clinical features of rheumatoid arthritis. In: Rheumatology. 6th edition. Elsevier Inc. 2015;704-11. 2. Dellhag B, Burckhardt CS. Predictors of hand function in patients with rheumatoid arthritis. Arthritis Care Res. 1995;8:16-20.
2. 3. Firestein GS, Budd RC, Gabriel SE, et al. Kelley's Textbook of Rheumatology E-Book. Elsevier Health Sciences. 2012.
3. 4. Pollard L, Choy E, Scott D. The consequences of rheumatoid arthritis: quality of life measures in the individual patient. Clin Exp Rheumatol. 2005;23:S43-52.
4. 5. Eberhardt K, Sandqvist G, Geborek P. Hand function tests are important and sensitive tools for assessment of treatment response in patients with rheumatoid arthritis. Scand J Rheumatol. 2008;37:109-12.
5. 6. Gürçay E, Alanoğlu E, Tuncay R, et al. The assessment of duruoz hand scale and grip ability test in the rheumatoid hand. T Klin FTR. 2004;4:1-6.
6. 7. Buljina AI, Taljanovic MS, Avdic DM, Hunter TB. Physical and exercise therapy for treatment of the rheumatoid hand. Arthritis Rheum. 2001;45:392-7.
7. 8. Taştekin N, Uzunca K, Birtane M, et al. The relationship of rangeof motion and grip strength of the hand with disease activity, hand functions and disability in patients with rheumatoid arthritis. Arch Rheumatol. 2006;21:13-7.
8. 9. Burmester GR, Pope JE. Novel treatment strategies in rheumatoid arthritis. Lancet. 2017;389:2338-48.

9. 10. Chadwick A. A review of the history of hand exercises in rheumatoid arthritis. Musculoskeletal Care. 2004;2:29-39.
10. 11. Malcus-Johnson P, Carlqvist C, Sturesson A-L, et al. Occupational therapy during the first 10 years of rheumatoid arthritis. Scand J Occup Ther. 2005;12:128-35.
11. 12. Rønningen A, Kjeken I. Effect of an intensive hand exercise programme in patients with rheumatoid arthritis. Scand J Occup Ther. 2008;15:173-83.
12. 13. Aletaha D, Ward MM, Machold KP, et al. Remission and active disease in rheumatoid arthritis: defining criteria for disease activity states. Arthritis Rheum. 2005;52:2625-36.
13. 14. Duruöz MT, Poiraudeau S, Fermanian J, et al. Development and validation of a rheumatoid hand functional disability scale that assesses functional handicap. J Rheumatol. 1996;23:1167-72.
14. 15. Uhlig T, Kvien TK. Is rheumatoid arthritis disappearing? Ann Rheum Dis. 2005;64:7-10.
15. 16. Firestein GS. Evolving concepts of rheumatoid arthritis. Nature. 2003;423:356-61.
16. 17. Lau CS, Chia F, Harrison A, et al. APLAR rheumatoid arthritis treatment recommendations. Int J Rheum Dis. 2015;18:685-713.
17. 18. Spiegel JS, Spiegel TM. Rheumatoid arthritis in the foot and ankle—diagnosis, pathology, and treatment: the relationship between foot and ankle deformity and disease duration in 50 patients. Foot Ankle. 1982;2:318-24.
18. 19. Suomi R, Collier D. Effects of arthritis exercise programs on functional fitness and perceived activities of daily living measures in older adults with arthritis. Arch Phys Med Rehabil. 2003;84:1589-94.
19. 20. Brorsson S, Hilliges M, Sollerman C, Nilsdotter A. A six-week hand exercise programme improves strength and hand function in patients with rheumatoid arthritis. J Rehabil Med. 2009;41:338-42.
20. 21. Häkkinen A, Sokka T, Kautiainen H, et al. Sustained maintenance of exercise induced muscle strength gains and normal bone mineral density in patients with early rheumatoid arthritis: a 5 year follow up. Ann Rheum Dis. 2004;63:910-6.
21. 22. Hoenig H, Groff G, Pratt K, et al. A randomized controlled trial of home exercise on the rheumatoid hand. J Rheumatol. 1993;20:785-9.
22. 23. O'brien A, Jones P, Mullis R, et al. Conservative hand therapy treatments in rheumatoid arthritis—a randomized controlled trial. Rheumatology (Oxford). 2006;45:577-83.
23. 24. Hall J, Skevington SM, Maddison PJ, Chapman K. A randomized and controlled trial of hydrotherapy in rheumatoid arthritis. Arthritis Care Res. 1996;9:206-15.
24. 25. Häkkinen A, Kautiainen H, Hannonen P, et al. Pain and joint mobility explain individual subdimensions of the health assessment questionnaire (HAQ) disability index in patients with rheumatoid arthritis. Ann Rheum Dis. 2005;64:59-63.
25. 26. Pincus T. Long-term outcomes in rheumatoid arthritis. Rheumatology. 1995;34:59-73.
26. 27. Kahn M-F. Can we estimate the incidence, prevalence, and outcomes of rheumatoid arthritis in France?. Joint Bone Spine. 2004;71:95-7.
27. 28. Kazis LE, Meenan RF, Anderson JJ. Pain in the rheumatic diseases. Investigation of a key health status component. Arthritis Rheum. 1983;26:1017-22.
28. 29. Doeglas D, Suurmeijer TP, Van den Heuvel W, et al. Functional ability, social support, and depression in rheumatoid arthritis. Qual Life Res. 2004;13:1053-65.
29. 30. Yazici Y, Pincus T, Kautiainen H, Sokka T. Morning stiffness in patients with early rheumatoid arthritis is associated more strongly with functional disability than with joint swelling and erythrocyte sedimentation rate. J Rheumatol. 2004;31:1723-6.
30. 31. Brighton S, Lubbe J, van der Merwe C. The effect of a long-term exercise programme on the rheumatoid hand. Rheumatol. 1993;32:392-5.
31. 32. Elden H, Nacitarhan V. Correlation of morning stiffness and acute phase reactants in patients with rheumatoid arthritis. Turk J Phys Med Rehabil. 2005;51:19-21.