Systematic Review Showcases Benefits of Nonpharmaceutical Interventions for Juvenile Idiopathic Arthritis

VBCR - February 2015, Volume 4, No 1 - Canadian Rheumatology Association Annual Meeting
Rosemary Frei, MSc

Several types of exercise regimens are useful in the management of juvenile idiopathic arthritis (JIA), according to a new review of the literature. A group from the University of Ottawa conducted a systematic literature search for nonpharmaceutical interventions that yielded 4 high-quality, randomized, controlled trials. They showed that individualized home exercise, strength training exercise, aquatic exercise, Pilates, and cardio-karate all have benefits for young people with arthritis.

Principal investigator Lucie Brosseau, PhD, has subsequently spearheaded the production of YouTube videos and other material on the internet to spread the word to youth, and their parents and healthcare providers, about these forms of exercise.

“I think all the medical professionals agree that we need a combination of both medication and nonpharmaceutical interventions because children with juvenile arthritis need to not just take medicine but to get out and be active,” Brosseau, Professor, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, told Value-Based Care in Rheumatology when the results were presented at the Canadian Rheumatology Association’s 2015 Annual Scientific Meeting.

Brosseau and her 13 co-authors, known as the Ottawa Panel, identified 47 full-text articles that addressed comparative controlled trials of different types of physical activity in JIA. However, only 5 provided high-quality, level 1 evidence.

One of the randomized, controlled trials was a comparison between patients who were using an individualized home exercise program and controls who were not exercising for 3 months. It showed grade A evidence for improvement of functional ability and quality of life. Another trial provided grade A evidence for significantly more improvement of joint status with aquatic aerobic fitness training than with normal daily activities. The third trial, which compared exercise to no exercise, showed modest benefits associated with a strength-training program for muscle torque.

Two other trials compared one type of physical activity to another. A study of Pilates versus a low-intensity standard workout program yielded grade A evidence for improvement of health-related quality of life with Pilates, as well as of pain, functional ability, and range of motion. Cardio-karate was compared to qigong in another randomized, controlled trial that yielded grade C+ evidence for an improvement in range of motion and number of active joints.

Among all the patients in all 5 trials there was only 1 who dropped out due to exacerbated symptoms. None of the others experienced any adverse effects.

The results were compelling enough for the members of the Ottawa Panel to recommend physical activity for the management of JIA. Brosseau also helped create a ‘People Getting a Grip on Arthritis’ website hosted by The Arthritis Society (www.arthritis.ca/peoplegettin gagrip and www.arthrite.ca/pren dreenmainvotrearthrite) and helped put together a video in French showing youth participating in a cardio-karate class. In addition, 2 of her graduate students are studying the best way to disseminate this new knowledge to patients, their parents, and healthcare providers across the country using new technologies.

“I’m very proud of these online dissemination efforts,” said Brosseau. “Because research isn’t useful it if just sits on the shelf.”

Reference

Brosseau L, Cavallo S, Toupin-April K, et al. Therapeutic exercises are effective strategies for pain management of juvenile idiopathic arthritis. Poster presented at: 2015 Canadian Rheumatology Association Annual Scientific Meeting; February 4-7, 2015; Quebec City, Quebec. Abstract 133.

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