AB0490 Kaltenborn's Manual Mobilization Method for Pain Relief in RA Hand Joints: Clinical and Ultrasound Findings in a Pilot Study

BackgroundPain is an important manifestation of rheumatoid arthritis (RA) and it is imperative to find complementary options for patients experiencing pain despite antirheumatic treatment. Kaltenborn's manual mobilization is a complementary and alternative medicine (CAM) method based on gentle traction and passive motion. It has been tested extensively in osteoarthritic joints and found to provide pain relief, but there are no published studies to date on the use of this method in RA hand joints under ultrasound (Doppler) surveillance.ObjectivesThe aim of this pilot study was to preliminarily assess the effectiveness of the Kaltenborn manual mobilization method in reducing tenderness, pain, and Doppler activity in patients with RA.MethodsA total of 110 hand joints (1 wrist, 5 MCPs & PIPs bilaterally) in 5 female patients with RA who did not respond to antirheumatic treatment were clinically examined with patient-reported outcomes (PROs) for joint swelling, tenderness, and pain (VAS). Using Kaltenborn's technique, the MCP2-5 joints in 1 randomized hand (4/5 patients, n=20) were manually mobilized. Synovitis, tenosynovitis and disease activity were evaluated using the ultrasound Doppler quantification method. Three treatment sessions, each with two segments, were carried out every 2nd day for 1 week.ResultsOut of the 20 MCP joints treated in the test-hand, 75% (15/20) were self-reported as tender. Of these, 67% (10/15) were non-tender after the 3rd treatment session (1 week). In the control-hand, 60% (12/20) were self-reported as tender. Of these, 50% (6/12) were non-tender after 1 week. Both hands combined yielded highly significant reductions in self-reported tenderness (27/40 vs. 11/40, OR 5.48 [2.10, 14.28], p