Controlled Trial of the Effect of Complete Immobilization of the Joints in Rheumatoid Arthritis.

It has long been accepted by the majority of physicians that rest in bed forms an important part of the treatment of rheumatoid arthritis during the active phase of the disease, but sharp differences of opinion have been expressed as to the correct treatment of inflamed joints during this phase. John Hunter (1835) stated that "nothing can promote the contraction of a joint so much as motion before the disease is removed". Hugh Thomas (1878) advocated immobilization ofinflamed joints, and maintained that even after prolonged fixation movement would return if cartilage was present in the joints. Sir Robert Jones (1909) warned against excessive movement of inflamed joints. The fear of ankylosis, however, has led many authorities to advocate a combination of splinting and active movement. Swaim (1934) was a pioneer in the use of light plaster of Paris splints to relieve pain and prevent deformity. These splints were moulded to the joints and did achieve complete immobilization, thus relieving both pain and muscle spasm. Nevertheless, Swaim believed that it was dangerous to leave these splints in place for more than 48 hours. He recommended daily movements after this initial period to prevent the formation of adhesions. Kindersley (1936) reported that he had immobilized inflamed joints for 2 weeks in unpadded plaster and noted reduction in signs of joint inflammation and muscle spasm. At the end of this period the majority of patients rapidly regained full movements; in others, however, the joints were stiff and in a few cases manipulation was needed to restore movement. He suggested that the bad reputation of this type of treatment might have been due to the use of padded wooden or metal splints which were never effective in achieving complete immobilization of a joint. Kindersley himself, however, later came to believe that the immobilization of inflamed joints for a week or more was contraindicated.