Effects of underwater ultrasound therapy on pain, inflammation, hand function and quality of life in patients with rheumatoid arthritis - a randomized controlled trial.

Objectives: To investigate the effects of underwater ultrasound (US) therapy in 48 patients with moderately active rheumatoid arthritis (disease activity score in 28 joints [DAS28]>3.2 and<5.1).

Methods: Patients randomly assigned to the ultrasound group (n=25) received underwater continuous ultrasound therapy to both wrists and hands for 7min per session with an intensity of 0.7W/cm for 10 sessions. The control group (n=23) received sham treatment under the same conditions. At baseline, at the end of treatment (end of Week 2) and at the follow-up visit (Week 14), the following outcomes were evaluated: disease activity (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], tender and swollen joint counts, pain on a visual analog scale, DAS28, hand function (fist making, wrist extension and flexion, hand grip strength) and quality of life (Health Assessment Questionnaire [HAQ]).

Results: A significant decrease in C-reactive protein at the end of Week 2 and Week 14 compared to control group (mean between-group difference at 2 weeks=-5.77, 95% CI=-10.86 to -0.68, mean between-group difference at 14 weeks=-5.07, 95% CI=-10.13 to -0.01), and non-significant decrease in DAS28 was observed. By the end of treatments at the end of week 2, ultrasound alleviated pain significantly (mean between-group difference at two weeks=-8.35 95% CI=-16.12 to -0.58), as well as improved left wrist extension compared to the control group (mean between-group difference at 14 weeks=4.35, 95% CI=1.09-7.60).

Conclusion: Underwater ultrasound therapy was better than sham treatment at the end of 2 weeks of treatment, but not at long term (14 weeks) in patients with rheumatoid arthritis.

Clinical Trial Registration Number: NCT02706028 (https://clinicaltrials.gov/ct2/show/NCT02706028).