The effect of mobilization with movement on pain, joint distance, effusion area, and inflammation in rheumatoid arthritis: a double-blind randomized controlled clinical trial

BACKGROUND: Effective management of established rheumatoid arthritis emphasizes on pain relief, disease control, joint preservation, and improved function and quality of life. This trial examines the effects of mobilization with movement on joint distance, effusion area, and inflammation in patients with established rheumatoid arthritis, with interventions applied to both hands. METHODS: A total of 76 participants were screened, and 21 met the inclusion criteria. Participants were randomly assigned to one of three groups: the mobilization group (MG) (n = 7), sham mobilization group (SMG) (n = 7), or control group (CG) (n = 7). The groups underwent a two-week traditional physiotherapy program. In addition, the MG received mobilization with movement (5 sessions per week, 15 min per session), while the SMG received squeeze-release application during the same period. The primary outcomes were the pre- and post-treatment comparison of pain, joint space, effusion area, and inflammation. The secondary outcomes included comparisons of hand function, dexterity, grip strength, disease activity, and quality of life. Participants were assessed at both baseline and post-treatment. RESULTS: Improvement in joint distance, effusion area and inflamation were greater in the MG. Joint space increased by 0.3 mm at the wrist and 0.2 mm at the MCP and PIP joints. Effusion at the PIP joint decreased by 0.04 mm², and inflammation was reduced by 50.59% at the wrist and 53.33% at the PIP joint. CONCLUSIONS: This study demonstrated that mobilization with movement effectively increases joint space and reduces inflammation in the wrist and PIP joints, improving the quality of life. Therefore, adding mobilizations to the conventional physiotherapy program might be beneficial to improve joint distance in RA patients. TRIAL REGISTRATION: Clinical Trial Registry-NCT05660629.