NonpharmaGological

i nterventions for rheumatoi d

arthritis
Kelly Shaw
This series of articles facilitated by the Cochrane Musculoskeletal Group (CMSG) aims to place the findings
of recent
MBBS, MPH, PhD, FRACGB
Cochrane musculoskeletal reviews in a c0ntext immediately relevantto general practitioners. This article considers
FAFPHM, is Specialist Medical
nonpharmacological interventions for rheumatoid arthritis.
Advisor, Population Health,
Department of Health and
Human Services, Hobart,
Tasmania. kelly.shaw@dhhs. Rheumatoid arthritis (RA) is a chronic, systemic guidance from their general practitioner on the usefulness
tas.gov.au
autoimmune disease characterised by persistent or otherwise of these interventions. ln this article we
Jane Zochling
inflammation of synovial joints. often leading to joint address: occupational therapy {OT), balneotherapy (bathing
N4BBS, FBACP. MMediClinEpi).
destruction and disability.The major goals of treatment in hot mineralised water, eithbr with minerals added or
PhD, is Besearch Fellow,
Menzies Research lnstitute. are to relieve pain, reduce inflammation, slow down in naturally occurring rrottpiidgisi, tai chi, acupuncture,
University of Tasmania. or stop joint damage, prevent disability, and preserve and low level laser therapy. The review results for
Tania Winzenherg or improve the patient's sense of wellbeing and ability each therapy are summarised in Table 7 and how these
IVBBS, FBACGq to function. results might affect practice are shown inTable 2.
MMedSciClinEpi). PhD, is
Research Fellow - General
Nonpharmacological interventions are an important part of Gonclusion
Practice, Menzies Fesearch
lnstitute, University of the management of RA, particularly chronic RA.r A range With the exception of some aspects of OI there was
Tasmania.
of interventions are available and patients may ask for insufficient evidence to demonstrate the effectiveness

Occupational therapy2
. The review included 38 studies (randomised controlled trials [RCTs], controlled clinical trials and uncontrolled studies) in 1700
adults with RA'Types of OT intervention considered were: comprehensive OT with elements of motor function
training, skills
training, instruction on joint prolection, counselling, advice on assistive devices, and provision of splints

t ' Numbers of studies assessing each intervention were small and the methodological quality of studies poor,
therefore conclusions
were based on the evidence judged to be of highest methodological quality
' There was strong evidence that instruction on joint proteetion and limited evidence that comprehensive
OT improved functional
ability
' Provision of splints may decrease pain and improve grip strength but reduce dexterity
t Motor function training does not affect pain or functional ability
o There were insufficient data to determine the eftectiveness of adyice about assistive devices, skills training
or counse{((ng
Balneotherapy3
r The review included six trials with 355 adults with RA.Treatment was 2-4
weeks with assessment at 3 months post-treatment. A
range of minerals was used
' Because most studies of balneotherapy are of poor methodological quality, the evidence is not
clear if overall this therapy
improves BA symptoms or function
' ln some studies, participants experienced improved morning stiffness, pain, walk time and ability to undertake
daily activities
Tai chia

' The review Included four studies with 202 adults with HA. Where participants attended classes, treatment duration
was &-10 weeks
and sessions were 6G-90 minutes. Control groups included in the review did not attend classes
r Because most studies of tai chi are of poor methodological quality, the evidence
is not clear if this therapy improves RA symptoms
or function, pain or quality of life

840 Reprilted lrom Australian taBily physician V01.36,N0, l0,0ctoter 2007