The effect of nerve mobilization exercise in patients with rheumatoid arthritis: a pilot study

Abstract

SUMMARYRheumatoid arthritis (RA) is an autoimmune disorder characterized by chronic inflammation of the joints. The neurogenic inflammatory mechanism plays an important role in the inflammatory process of RA, and pathological changes in neural tissues in RA have also been noted. We aim to investigate treatment of the nervous system to relieve joint pain and inflammation in RA. Nerve mobilization, a nervous system-specific therapeutic exercise, was applied on RA patients to determine the effect of nerve mobilization on joint inflammation. Twelve RA patients were recruited from the community and were randomised into an experimental and a control group. In the experimental group, the subjects were taught a set of nerve mobilization exercises while the subjects in the control group were taught a set of gentle joint mobilization exercises. Both groups were instructed to practice the exercises daily. After a 4-week period, their RA pain scale (RAPS) and pain scores were examined, as well as the C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Subjects in the experimental group showed improvements in RAPS and pain scores after 4 weeks of nerve mobilization exercises, while CRP and ESR values remained unaffected. These preliminary data showed that nerve mobilization exercises might be beneficial in controlling joint pain in RA patients. Reumatismo, 2017; 69 (3): 111-118 n INTRODUCTION R heumatoid arthritis (RA) is one of the most prevalent chronic autoimmune diseases. The symptoms of RA are characterized by joint inflammation and deformities that are associated with pain and functional disability (1). The aetiology of RA remains unclear, but an increasing number of investigations have provided evidence that disease perpetuation could be due to a mixture of both immunogenic (1) and neurogenic (2, 3) inflammation. The mechanism of neurogenic inflammation has been described as an inflammation that is initiated by the nervous system (4-6). The neurogenic inflammation is triggered in the tissues by the cutaneous nerves (4, 7-10). The evidence of neurogenic inflammation in RA is supported by a small but significant number of tyrosine hydroxylase-positive sympathetic nerve fibres, which have a negative correlation with the inflammation index, a large number of substance P-positive nerve fibres (11) and immunoreactive sensory nerve fibres with calcitonin gene-related peptide (CGRP) (12). The current treatment algorithms for RA involve the use of both traditional and biological disease-modifying antirheumatic drugs (DMARDs) to control the disease (13). Physical treatments are also beneficial for patients to optimize physical functions, decreasing pain and improving quality of life (14-16). A paradigm is named as neurodynamic, which is a series of movements that produce physiological and mechanical events in the nervous system. They are used in physical testing to gain a response to the mechanical performance and sensitivity of the nervous sys- Key words: CRP; ESR; Nerve mobilisation; Neurogenic inflammation...

Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs

“…One meta-analysis of hand muscle strengthening exercises,137 three systematic reviews (one including a 2012 meta-analysis138)77 139 140 17 reports of RCTs and long-term extensions,128 131 141–155 1 non-randomised trial156 and 1 single-arm study157 assessed muscle strengthening exercise in RA. Small effects from muscle strengthening exercise were reported on pain77 137 138 140 141 143 144 153 (meta-analysis138: MD pain Visual Analogue Scale −4.13 (95% CI −10.97 to 2.71)).…”

“…One meta-analysis of hand muscle strengthening exercises,137 three systematic reviews (one including a 2012 meta-analysis138)77 139 140 17 reports of RCTs and long-term extensions,128 131 141–155 1 non-randomised trial156 and 1 single-arm study157 assessed muscle strengthening exercise in RA. Small effects from muscle strengthening exercise were reported on pain77 137 138 140 141 143 144 153 (meta-analysis138: MD pain Visual Analogue Scale −4.13 (95% CI −10.97 to 2.71)). Inconsistent results were reported in terms of function, with several studies reporting improvements in function77 137 138 143 148 149 151 (meta-analysis138: MD Health Assessment Questionnaire −0.22 (95% CI −0.35 to –0.10)), whereas other RCTs reported no benefit,128 144 147 152 153 potentially due to differences in the comparison group where some were given low-intensity exercise or exercise advice.…”

Effectiveness of Neural Mobilisation on Pain Intensity, Functional Status, and Physical Performance in Adults with Musculoskeletal Pain – A Systematic Review with Meta-Analysis

“…Both studies used active techniques. No significant difference between groups was found for pain intensity (k = 2, high risk of bias 78,79 ; effect size = −0.43, 95% confidence interval: −1.16; 0.29). Lau et al 78 also assessed the functional status and reported no significant difference between groups.…”

“…Included studies (n = 39) cover 10 musculoskeletal conditions: hand osteoarthritis (n = 3), 49,50,80,87 lateral epicondylitis (n = 4), 61,83,84,86 ankle sprain (n = 1), 72 shoulder impingement syndrome (n = 1), 85 rheumatoid arthritis (n = 2), 78,79 unspecified musculoskeletal pain (n = 1), 77 fibromyalgia (n = 1), 76 plantar heel pain syndrome (n = 1), 75 low back pain (n = 17), [58][59][60][62][63][64][65][66][67][68][69][70][71]73,74,81,82 and neck pain (n = 8). [51][52][53][54][55][56][57]88 Studies characteristics are summarised in Tables 2 to 11.…”

“…Of these, 27 reports were excluded and 40 remained for this systematic review, considering that 14 studies were included from other sources. Taking into account that two reports were related to the same study, 49,50 a total of 39 studies were included 49–88 (Figure 1). The excluded reports are listed in Supplemental File 4 with the reasons for exclusion.…”