Joint mobilization of the hands as a potential method for reducing pain and improving ultrasound outcomes in patients with rheumatoid arthritis: an assessor-blinded, randomized crossover study

Background: Despite major advances in treating rheumatoid arthritis (RA) with disease-modifying antirheumatic drugs, a considerable number of patients still experience chronic pain. Novel, integrative approaches are thus warranted. Aim: The purpose of this study was to assess the clinical feasibility, safety, and effectiveness of Kaltenborn manual mobilization of the hands in RA. Methods: Twelve participants with RA and eight with hand osteoarthritis (OA) as a clinical comparator group were recruited to receive low-grade (I-II) Kaltenborn manual mobilization for 1 month, with a follow-up at month 2. One hand per participant was randomized to receive treatment at weeks 1 and 2. The control hand was crossed over to receive treatment at weeks 3 and 4. Clinical outcome measures such as hand pain by visual analog scale was assessed together with inflammation and radiographic joint space with musculoskeletal ultrasound. Key findings: Regardless of which hand was treated, hand pain, inflammation and joint space improved in the RA group from baseline to crossover to follow-up at 2 months. Hand pain and joint space also improved in OA. No dropouts or adverse events were reported in either the RA or OA group. Conclusions: Manual mobilization of the hands in RA was shown to be feasible, safe, and effective to integrate into specialized healthcare.