Exercise therapy and orthotic devices in rheumatoid arthritis: evidence-based review.

Current Opinion in Rheumatology 2008, 20:353–359 Key points (1) Rheumatoid arthritis is a chronic, systemic inflammatory disease of the periphera joints that causes painful disability and reduces patients’ physical function, with a substantial negative impact on health-related quality of life (HRQL). (2) Exercise therapy, including aerobic or strengthening exercises, and orthotic devices are utilised in conjunction with pharmacological therapies to improve the symptoms o pain and fatigue and improve HRQL in rheumatoid arthritis patients. (3) Randomised, controlled trials demonstrate the beneficial effects of regular aerobic exercise and/or strengthening exercises on physical function and symptoms of pain and fatigue in rheumatoid arthritis patients. However, exercise therapy does not appear to improve disease activity. (4) Pain and physical function were significantly improved with standard or customised foot orthoses in small, controlled or crossover studies, and with wrist splints in two randomised, controlled trials in rheumatoid arthritis patients. (5) More data from large, well-controlled studies are required to fully elucidate the role o exercise therapy and orthotic devices in the management of rheumatoid arthritis. In particular, studies evaluating the use of these therapies on disease activity would be useful.