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Therapy May Not Help Early Rheumatoid Arthritis

Mon January 5, 2004

NEW YORK (Reuters Health) - Occupational therapy has been shown to help people who have had rheumatoid arthritis for several years or longer, but the results of a new study suggest that people in the early stages of the disease do not achieve any functional benefits.

"This study suggests that rheumatology departments should think twice before providing early secondary preventive intervention to everyone with rheumatoid arthritis," Dr. Alison Hammond of Derbyshire Royal Infirmary in London and colleagues report in the January issue of the journal Annals of the Rheumatic Diseases.

In rheumatoid arthritis, the immune system attacks the tissues that line the joints, leading to pain, inflammation and deformity. The disease affects more women than men, and it may attack other organs in the body.

Occupational therapy includes both therapeutic and educational interventions that are designed to help people adjust to rheumatoid arthritis and improve or maintain their daily activities. One of the aims of occupational therapy for rheumatoid arthritis is to help people maintain hand function.

Occupational therapy has been shown to be beneficial in people who have had rheumatoid arthritis for 8 to 10 years. Whether this type of intervention is helpful to people with early disease, in which symptoms tend to be less severe, is uncertain.

Despite this uncertainty, there has been a move toward providing occupational therapy and education to people with early rheumatoid arthritis, according to the report.

To test the effectiveness of such a strategy, Hammond's team studied a group of people who had been diagnosed with rheumatoid arthritis for less than 2.5 years. About 300 people were randomly assigned to receive conventional treatment with or without occupational therapy.

On average, participants in the occupational therapy group received more than 7 hours of occupational therapy.

By the end of the 2-year study, people in the occupational therapy group were more likely to "self-manage" their disease. Examples of self-management include performing hand exercises and wearing splints or other joint protection.

Other than self-management, though, researchers did not observe any significant differences between the groups in terms of health status.

Hammond and her colleagues suggest several explanations, including that drugs used to treat rheumatoid arthritis might have "erased" any of the benefits of occupational therapy early in the disease process.

They also point out that the study might not have been long enough to detect any differences in the occupational therapy group.

"Research is needed to determine the best choices of occupational therapy interventions for whom and when in this group of patients with early disease," Hammond and her colleagues conclude.

SOURCE: Annals of the Rheumatic Diseases, January 2004.

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