A brief report on the clinical trial on neural mobilization exercise for joint pain in patients with rheumatoid arthritis

Z Rheumatol. 2019 Jun;78(5):474-478. doi: 10.1007/s00393-018-0521-7.

Abstract

Background: In rheumatoid arthritis (RA) synovitis, activation of synoviocytes and infiltration of adaptive immune cells leads to synovial hyperplasia and joint swelling. Under the elevated extra-neural pressure, free nerve endings release neuropeptides, calcitonin gene-related peptide, and substance P, thus promoting neurogenic inflammation.

Objective: This study aimed to assess the effect of therapeutic neural mobilization (NM) exercises targeting the nervous system on disease impact in RA patients.

Methods: A total of 21 RA patients were randomized into NM (n = 11) and control (n = 10) groups. NM group patients performed NM exercises targeting the median, musculocutaneous, femoral, and saphenous nerve, as well as the entire nervous system twice daily for 4-8 weeks. Control RA patients performed gentle joint mobilization exercises targeting the same joints. Primary outcome was the change in pre-/post-treatment score in the validated Rheumatoid Arthritis Impact of Disease (RAID). Secondary outcome was erythrocyte sedimentation rate (ESR).

Results: There were no significant differences between the groups at baseline. No adverse events were observed and compliance was over 90%. Post-treatment, favorable changes were observed in the NM group RAID score: -5.1 vs. -0.8; weighted RAID score: -0.79 vs. -0.15. ESR was reduced in the NM group, albeit non-significantly. Regarding the RAID score domains, the NM group demonstrated significant improvements in pain and coping.

Conclusion: The current data indicate a beneficial effect of NM exercises on pain and self-efficacy in our RA patients. Larger clinical studies are warranted to determine the clinical effectiveness of NM as a treatment for pain for RA patients and simultaneously address immune and neuropeptide modulation through NM.

Keywords: Autoimmune diseases; Blood sedimentation; Nervous system; Physiotherapy; Questionnaires.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Arthralgia / etiology
  • Arthralgia / rehabilitation*
  • Arthritis, Rheumatoid* / complications
  • Female
  • Humans
  • Middle Aged
  • Nervous System
  • Reproducibility of Results
  • Sickness Impact Profile*
  • Synovitis