Rheumatoid Arthritis is one of the most common chronic autoinflammatory conditions observed in the human population. It is characterised by joint swelling, pain, and gradual degradation of the joint leading to decreased mobility and quality of life, making it a significant concern for sufferers. As Rheumatoid Arthritis is a complex disease, the genetic background determining the development of the illness is not well understood. Medical and pharmaceutical management of the condition is common, but what role can chiropractic play in its management? At least two case reports indicate this is a possibility.
The first case, published in the Chiropractic Journal of Australia, covered a 32-year-old female with a diagnosis of rheumatoid arthritis. She presented to a chiropractic clinic complaining of wrist and hand stiffness on both sides along with joint effusion (fluid/swelling). She was seeing a rheumatologist who had diagnosed her many years back, and was also seeing a chiropractor and receiving pharmacological treatment with methotrexate (an immunosuppressant).
After a thorough examination, she commenced a course of chiropractic care in which she was seen once a week for eight weeks. During each session, her spine was evaluated and adjusted with cervical (neck area) adjustments. As the chiropractic did not advise her against her medical management, she was only adjusted if she was up to date with her methotrexate injections.
It is interesting to note that she did not complain of any increasing pain or stiffness during the treatment plan. This is noteworthy, as pain and stiffness are hallmarks of the condition and may be a factor that people consider when deciding whether or not to try chiropractic care. In fact, following the second session of chiropractic care, she reported that, although she still had some weakness, she could now make a fist and touch thumb and finger together which indicated a significant increase in manual dexterity.
The chiropractor performed a number of pre-intervention tests at the commencement of her care plan and ran them again intermittently and after eight weeks. It was noted that;
- Grip strength increased in both arms/hands following adjustment at the first session
- Before and after adjustments at the first session she could not oppose the thumb and index finger or make a fist. At the end of her care plan, and the 8th adjustment she was able to oppose the thumb and index finger with normal strength.
- She reported, for her activities of daily life, that she noticed an increase in grip strength and could hold heavy items in her right hand without bracing with the left hand. Her left hand was getting better but still required bracing to support heavy items.
- Her rheumatologist told her that her hands had not looked this good in years.
One limitation of this study was that an appointment in the care plan was missed and rescheduled for the following week. This may explain a fluctuation in her recovery trajectory, but this is only speculation. While it is true that she received a combination treatment with a rheumatologist and a chiropractor, this doesn’t invalidate the findings. It just indicates that chiropractic care can work in well with pharmacological interventions, and in this case it may have been a factor in improving her response to care.
The second case appeared in the Journal of Chiropractic Medicine and detailed chiropractic care of a 48-year-old woman who presented with hand pain, stiffness, swelling, redness in both hands of a duration of one year. Interestingly, she was referred to a chiropractor by her primary care provider. At the commencement of care, she rated her pain as a 10/10 prior to intervention. She experienced stiffness that was constant and lasted all day and her right hand was more severely affected than the left. It was confirmed via diagnostic imaging that she had an inflammatory disease – osteoarthritis. It is a worthy note here that osteoarthritis overlaps with rheumatoid arthritis on many features.
Again, this patient reported no adverse events when she commenced chiropractic care, nor were any reported over the course of her care plan. Alongside her chiropractic interventions (including manual adjustments) she also continued her normal care plan which included low level laser therapy along her joints as well as exercises to improve finger extension and flexion.
At her one-month re-evaluation, tenderness persisted in some joints, but full pain-free finger range of motion was regained as well as full strength in fingers. She now reported no pain with activities of daily life and no impact on her work. This was a significant difference as her original consultation included a 10 out of 10 on the numerical pain scale.
While the case report does not carry details of other medication or of the length of the affect, it does illustrate some pretty compelling results under chiropractic care.
Other case reports do exist which also detail recovery from arthritic symptoms under chiropractic care. While case reports are often underappreciated in terms of evidence, they do give us insight into the potential for chiropractic care to assist with inflammatory conditions without exacerbating symptoms. This surely is welcome relief to anyone who had wondered whether arthritis excluded them from the benefits of chiropractic.
References:
- Grocholski M, Jordahl J. Treatment of Wrist and Metacarpal Phalangeal Joint Effusion Related to Rheumatoid Arthritis with Therapeutic Ultrasound: A Case Report. Chiropractic Journal of Australia. 2017. 45(3):229-235
- Lewis KL, Battaglia PJ. Differentiating Bilateral Symptomatic Hand Osteoarthritis From Rheumatoid Arthritis Using Sonography When Clinical and Radiographic Features Are Nonspecific: A Case Report. Journal of Chiropractic Medicine. 2019. 18(1):56–60.
