Clinical Study On Improving Hand Function In Patients With Rheumatoid Arthritis By Yijinjin

Background and Objective:Rheumatoid arthritis(RA)is highly disabling,and about 70%of RA patients may develop bone erosion,which eventually leads to joint deformity and dysfunction.Hand and wrist joints are most commonly involved,thus 80%of RA patients with hand dysfunction.The role of functional exercise in the treatment of RA has gradually become prominent,and professional rehabilitation therapy can improve the dysfunction of RA patients.Currently,there are relatively few clinical studies focusing on hand function.YiJinJing is a characteristic rehabilitation exercise program of traditional Chinese medicine.It can stretch tendons and bones,relieve muscle spasms,and relax the body and mind.It is suitable for RA patients to recover function.This study aims to evaluate the efficacy and safety of "YiJinJing" on the hand function of RA patients by carrying out randomized controlled trials,hoping to provide evidence for YiJinJing to improve RA hand dysfunction,and to improve the contribution of Chinese medicine specialties in the rehabilitation treatment of RA.Methods:This study adopted randomized,open,single-center,controlled clinical research.A total of 66 RA patients who met the criteria were randomly divided into a control group and a trial group,with 33 patients in each group.The control group was maintained on conventional medication and given joint rehabilitation instructions,while the experimental group was given "Yi Jin Jing" rehabilitation exercises,3 times a week,1 hour each time,for 12 weeks.The improvement of the Michigan Hand Function Scale(MHQ)at 12 weeks was used as the main efficacy index,and the improvement of hand function was evaluated by handgrip strength,active joint range of motion,and inflammation under joint ultrasound.At 12 weeks,morning stiffness duration,the overall disease VAS score,number of tender joints,number of swollen joints,number of deformed joints,rheumatoid factor(RF),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),and DAS28 score were used to evaluate the disease activity.The HAQ score was used to assess the improvement in the quality of life.The self-rating anxiety scale(SAS)and the self-rating depression scale(SDS)were used to evaluate the improvement of negative emotions.The safety of the patients was evaluated by electrocardiogram,vital signs,and liver and kidney function.Results:1.Baseline comparison:A total of 66 subjects were included,60 subjects completed the experiment,30 in the test group,and 30 in the other.At baseline,no statistically significant differences were found between the two groups in age,gender,height,weight,disease activity,hand function(MHQ,handgrip strength,active joint range of motion),and vital signs,indicating that the test and control groups were well comparable.2.Primary efficacy indicators:After 12 weeks of treatment,the MHQ scores of both groups were improved compared with baseline(P<0.05),with the test group showing more significant improvement than the control group(P<0.05).3.Secondary efficacy indicators:①Handgrip strength:After 12 weeks of treatment,the left and right handgrip strengths of the experimental group were significantly improved compared with baseline(P<0.05),while the control group did not signify significant improvement(P>0.05).Compared with the control group,the test group made a definite improvement in handgrip difference(P<0.05).②Active joint range of motion:After 12 weeks of treatment,the dorsiflexion,volar flexion,ulnar deviation,radial deviation,metacarpophalangeal joint flexion,and proximal interphalangeal joint flexion angles of both wrists were significantly improved in the test group(P<0.05),while all joint mobility improved in the control group(P<0.05)except for ulnar deviation;Compared with the control group,the test group significantly outperformed in terms of dorsal extension,radial deviation,and metacarpophalangeal joint flexion of both wrists(P<0.05),whereas palmar flexion,ulnar deviation,PIP flexion,and metacarpophalangeal joint dorsal extension of both wrists did not differ between the groups(P>0.05).③RA disease activity:After 12 weeks of treatment,morning stiffness duration,the overall VAS score,TJC,SJC,and DAS28-ESR score in the experimental group were notably improved compared with baseline(P<0.05),RF,ESR,and CRP were reduced but showing no significant difference(P>0.05).As for the control group,only morning stiffness duration and the overall VAS score display obvious statistical differences(P<0.05).In comparison with the control group,morning stiffness duration,the overall disease VAS score,DAS28-ESR score,ESR,and CRP were all remarkably ameliorated(P<0.05).④HAQ score:After 12 weeks of treatment,HAQ scores improved in both the control and test groups compared with baseline(P<0.05).The test group was observably better than the control(P<0.05).⑤SAS and SDS scores:After 12 weeks of treatment,both groups were improved compared to baseline(P<0.05).Despite the test group not improved significantly versus the control(P>0.05),the difference between two groups was statistically significant(P<0.05).⑥Joint ultrasound score:At 12 weeks of treatment,although no statistically significant were shown,the total score of unilateral wrist joint ultrasound in the test group was reduced compared with baseline(P>0.05).It signally observed a reduction in the total score of ultrasound in the experimental group versus the control(P<0.05).4.Safety assessment:Following a 12-week intervention,neither group of individuals showed any adverse events or substantial abnormalities in their vital signs,ECG,blood or urine tests,and liver,or kidney functions.Conclusions:1.YiJinJing exercise can improve hand function in patients with low disease activity RA:①YiJinJing exercise can significantly improve Michigan Hand Function Scale scores in RA patients and improve RA patients’ satisfaction with hand function;②YiJinJing exercise can significantly improve handgrip strength and active range of motion,improve hand strength and flexibility in RA patients;③YiJinJing exercise can reduce synovitis and tenosynovitis under ultrasound in RA patients.2.YiJinJing exercise can assist in reducing disease activity in RA patients.3.YiJinJing exercises can considerably enhance the quality of life of RA patients.4.YiJinJing exercises can greatly alleviate the anxiety and depression of RA patients.5.YiJinJing exercise is safe and effective for RA patients.