Abstract
BackgroundArthritis (or compression) gloves are widely prescribed to people with rheumatoid arthritis and other forms of hand arthritis. They are prescribed for daytime wear to reduce hand pain and improve hand function, and/or night-time wear to reduce pain, improve sleep and reduce morning stiffness. However, evidence for their effectiveness is limited. The aims of this study were to investigate the clinical and cost effectiveness of arthritis gloves compared to placebo gloves on hand pain, stiffness and function in people with rheumatoid arthritis and persistent hand pain.MethodsA parallel randomised controlled trial, in adults (≥ 18 years) with rheumatoid or undifferentiated inflammatory arthritis at 16 National Health Service sites in the UK. Patients with persistent hand pain affecting function and/or sleep were eligible. Randomisation (1:1) was stratified by recent change (or not) in medication, using permuted blocks of random sizes. Three-quarter-finger length arthritis gloves (Isotoner®: applying 23-32 mmHg pressure) (intervention) were compared to loose-fitting placebo gloves (Jobskin® classic: providing no/minimal pressure) (control). Both gloves (considered to have similar thermal qualities) were provided by occupational therapists. Patients and outcome assessors were blinded; clinicians were not. The primary outcome was dominant hand pain on activity (0–10) at 12 weeks, analysed using linear regression and intention to treat principles.ResultsTwo hundred six participants were randomly assigned (103 per arm) and 163 (84 intervention: 79 control) completed 12-week follow-up. Hand pain improved by 1.0 (intervention) and 1.2 (control), an adjusted mean difference of 0.10 (95% CI: − 0.47 to 0.67; p = 0.72). Adverse events were reported by 51% of intervention and 36% of control group participants; with 6 and 7% respectively, discontinuing glove wear. Provision of arthritis gloves cost £129, with no additional benefit.ConclusionThe trial provides evidence of no clinically important effect of arthritis gloves on any of the trial outcomes (hand pain, function and stiffness) and arthritis gloves are not cost-effective. The clinical and cost-effectiveness results support ceasing provision of arthritis gloves in routine clinical practice. Funding: National Institute for Health Research.Trial registrationISRCTN, ISRCTN25892131; Registered 05/09/2016: retrospectively registered.
Highlights
Rheumatoid arthritis (RA) affects 1% of the world’s population [1]
Therapists ensure a “snug fit” around the proximal interphalangeal joints (PIPJs), metacarpophalangeal joints (MCPJs) and across the dorsum of the hand, i.e. to ensure enough compression is applied without restricting circulation to the fingers or causing pins and needles
In the Arthritis Gloves (A-GLOVES) trial we aimed to investigate, for people with RA and undifferentiated inflammatory arthritis (UIA) with persistent hand pain, the comparative clinical and costeffectiveness of providing arthritis gloves or placebo gloves in addition to usual care
Summary
Rheumatoid arthritis (RA) affects 1% of the world’s population [1]. Disease modifying anti-rheumatic drugs (DMARDs) are prescribed as soon as possible to control symptoms, including to those with persistent synovitis where other pathologies are ruled out but not yet meeting criteria for RA, i.e. undifferentiated inflammatory arthritis (UIA). A survey of occupational therapists in the UK identified that the most common model and make prescribed are three-quarter length finger Isotoner® gloves (Fig. 1) [4] They are prescribed for daytime wear to reduce hand pain and improve hand function, and/or night-time wear to reduce pain, improve sleep and reduce morning stiffness [4, 5]. Arthritis (or compression) gloves are widely prescribed to people with rheumatoid arthritis and other forms of hand arthritis They are prescribed for daytime wear to reduce hand pain and improve hand function, and/ or night-time wear to reduce pain, improve sleep and reduce morning stiffness. The aims of this study were to investigate the clinical and cost effectiveness of arthritis gloves compared to placebo gloves on hand pain, stiffness and function in people with rheumatoid arthritis and persistent hand pain
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