• Levitsky A
• Kisten Y
• Lind S
• Nordström P
• Hultholm H
• Lyander J
• Hammelin V
• Gentline C
• Giannakou I
• Faustini F
• Skillgate E
• van Vollenhoven R
• Sundberg T

• Affiliation / Amsterdam University Medical Centers (UMC)
• Affiliation / Karolinska Institutet and Karolinska University Hospital. Department of Medicine, Solna. Rheumatology Unit
• Affiliation / Karolinska Institutet and Karolinska University Hospital. Department of Medicine, Solna. Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID)
• Affiliation / Karolinska Institutet. Care Sciences and Society. Department of Neurobiology
• Affiliation / Karolinska Institutet. Institute of Environmental Medicine. Musculoskeletal & Sports Injury Epidemiology Center
• Affiliation / Min Doktor International
• Affiliation / Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine
• Affiliation(G) / Netherlands / Amsterdam
• Affiliation(G) / Sweden / Malmö
• Affiliation(G) / Sweden / Stockholm
• Arthritis, Rheumatoid / therapy
• Hand Joints / physiopathology
• Manipulation, Joint
• Ultrasonography, Doppler

OBJECTIVE: The purpose of this study was to assess the clinical feasibility and effectiveness of manual mobilization of the hands of patients with rheumatoid arthritis (RA).

METHODS: A total of 320 individual hand joints were evaluated after recruiting an experimental research group of 12 participants with RA and, for clinical comparability, 8 participants with hand osteoarthritis (OA). One hand per participant was randomized to receive weekly low-grade (I-II) Kaltenborn manual mobilization, using passive sustained stretch of the metacarpophalangeal (MCP) joints II to V by licensed manual therapists. After 2 weeks, the randomized treated hand was crossed over to control (untreated) during weeks 3 to 4 and vice versa. Final assessment was at 2 months, which was 1 month after the last treatment at week 4. Primary hand outcomes included pain by visual analog scale, tender or swollen joint count, and presence of Doppler signal or synovial fluid and radiographic joint space by musculoskeletal ultrasound.

RESULTS: In the RA group, both the initially randomized treated hand and the contralateral hand improved significantly from baseline to crossover to follow-up at 2 months (pain outcomes and Doppler signal, P < .050; synovial fluid and MCP joint space, P ≤ .001). Hand pain and MCP joint space also improved significantly in OA. There were no dropouts or reported adverse events in either the RA or OA group.

CONCLUSION: In this study, manual mobilization of the hands of patients with RA was shown to be feasible, safe, and effective to integrate into specialized healthcare.

Author keywords: Arthritis, Rheumatoid, Osteoarthritis, Musculoskeletal Manipulations, Integrative Medicine, Ultrasonography, Doppler

Author affiliations: AL, YK, CG, IG, FF, VH, RV: Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; AL, YK, CG, IG, FF: Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; SL, PN, HH, JL, ES: Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden; VH: Min Doktor International, Malmö, Sweden; ES: Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; RV: Amsterdam University Medical Centers (UMC), Amsterdam, The Netherlands; TS: Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden

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