Joint Protection Research Articles

Bi-level Protected Compressive Sampling

Some pioneering works have investigated embedding cryptographic properties in compressive sampling (CS) in a way similar to one-time pad symmetric cipher. This paper tackles the problem of constructing a CS-based symmetric cipher under the key reuse circumstance, i.e., the cipher is resistant to common attacks even a fixed measurement matrix is used multiple times. To this end, we suggest a bi-level protected CS (BLP-CS) model which makes use of the advantage of the non-RIP measurement matrix construction. Specifically, two kinds of artificial basis mismatch techniques are investigated to construct key-related sparsifying bases. It is demonstrated that the encoding process of BLP-CS is simply a random linear projection, which is the same as the basic CS model. However, decoding the linear measurements requires knowledge of both the key-dependent sensing matrix and its sparsifying basis. The proposed model is exemplified by sampling images as a joint data acquisition and protection layer for resource-limited wireless sensors. Simulation results and numerical analyses have justified that the new model can be applied in circumstances where the measurement matrix can be re-used.

Shea Nut Oil Triterpene Concentrate Attenuates Knee Osteoarthritis Development in Rats: Evidence from Knee Joint Histology.

BackgroundShea nut oil triterpene concentrate is considered to have anti-inflammatory and antioxidant properties. Traditionally, it has been used to treat arthritic conditions in humans. This study aimed to investigate the effect of attenuating osteoarthritis (OA)-induced pain and joint destruction in rats by administering shea nut oil triterpene concentrate (SheaFlex75, which is more than 50% triterpenes).MethodsAn anterior cruciate ligament transaction (ACLT) with medial meniscectomy (MMx) was used to induce OA in male Wistar rats. Different doses of SheaFlex75 (111.6 mg/kg, 223.2 mg/kg, and 446.4 mg/kg) were then intragastrically administered daily for 12 weeks after surgery. Body weight and the width of the knee joint were measured weekly. Additionally, incapacitance tests were performed at weeks 2, 4, 6, 8, 10 and 12 to measure the weight bearing of the hind limbs, and the morphology and histopathology of the medial femoral condyles were examined and were evaluated using the Osteoarthritis Research Society International (OARSI) scoring system.ResultsThis study showed that SheaFlex75 reduced the swelling of the knee joint with OA and rectified its weight bearing after ACLT plus MMx surgery in rats. Treatment with SheaFlex75 also decreased ACLT plus MMx surgery-induced knee joint matrix loss and cartilage degeneration.ConclusionSheaFlex75 relieves the symptoms of OA and protects cartilage from degeneration. SheaFlex75 thus has the potential to be an ideal nutraceutical supplement for joint protection, particularly for injured knee joints.

Gender Disparities in Caregiver Stress for Providing Help to Older Mexican-Americans: A Descriptive Study of the HEPESE

Abstract Date Presented 4/9/2016 Women report greater burden (arthritis and depressive symptoms) associated with caregiving than do men. Occupational therapists can provide education in joint protection, body mechanics, and assistive devices for caregivers with painful joints, as well as teach techniques to alleviate depressive symptoms. Primary Author and Speaker: Diane M. Collins Contributing Authors: Amit Kumar, Brian Downer, Amol Karmarkar, Kyriakos S. Markides

Special anticorrosion coatings (sealing pastes) for high-strength steel resistance spot welding

The results of application of new anticorrosion coatings (sealing pastes) during resistance spot welding, which provide for protection of weld joints from corrosive action, are given. The studied anticorrosion coatings (sealing pastes) are proved to allow for flawless weld joints of 30KhGSN2A and Kh15N5D2T steel without degrading their mechanical properties.

How Can Joint Protection Apply to Grocery Shopping?; An Evaluation to Determine the Optimal Handle Diameter of Shopping Carts.

How Can Joint Protection Apply to Grocery Shopping?; An Evaluation to Determine the Optimal Handle Diameter of Shopping Carts.

The role of meniscal tissue in joint protection in early osteoarthritis.

It is widely accepted that partial meniscectomy leads to early onset of osteoarthritis (OA). A strong correlation exists between the amount and location of the resected meniscus and the development of degenerative changes in the knee. On the other hand, osteoarthritic changes of the joint alter the structural and functional integrity of meniscal tissue. These alterations might additionally compromise the limited healing capacity of the meniscus. In young, active patients without cartilage damage, meniscus therapy including partial meniscectomy, meniscus suture, and meniscus replacement has proven beneficial effects in long-term studies. Even in an early osteoarthritic milieu, there is a relevant regenerative potential of the meniscus and the surrounding cartilage. This potential should be taken into account, and meniscal surgery can be performed with the correct timing and the proper indication even in the presence of early OA.

Kinesio Taping® of the metacarpophalangeal joints and its effect on pain and hand function in individuals with rheumatoid arthritis.

BackgroundIn persons suffering from rheumatoid arthritis (RA), the metacarpophalangeal (MCP) joints are commonly affected, resulting in inflammation, pain, joint instability, diminished grip strength and difficulties with function. However, the effectiveness of Kinesio Taping® of the MCP joints in alleviating the symptoms has not been established.AimTo determine the effectiveness of bilateral Kinesio Taping® of the MCP joints on pain, range of motion, grip strength and hand function in elderly individuals previously diagnosed with RA.MethodsA repeated measure, experimental design was used over a 7-week period with the Kinesio Taping group (n = 30) receiving bilateral space correction Kinesio Taping® of the MCP joints with a joint protection (JP) group (n = 31) participating in JP workshops. The Kinesio Tape® was worn for 3 days a week with four applications during the data collection process. For the control group, 2-hour JP educational–behavioural workshops were run weekly for 4 weeks. Weekly assessments were completed for grip strength, ulnar deviation and pain (VAS), and two pre-intervention assessments and one post-intervention assessment was completed for the Michigan Hands Outcomes Questionnaire (MHQ).ResultsKinesio Taping® of the MCP joints showed a significant decrease in pain (p = 0.001) and improved range of motion (p = 0.001 bilaterally). JP was found to have a significant improvement in grip strength (p = 0.001 bilaterally) and in the work (p = 0.01) and activities of daily living (ADL) (p = 0.01) sections of the MHQ. No significant difference was found between groups after intervention in the majority of outcomes (p = 0.24) except for grip strength where a significant difference was found.ConclusionKinesio Taping® of the MCP joints is an effective conservative intervention to improve pain and MCP ulnar deviation in individuals with RA.Significance of the work: Kinesio Taping® of the MCP joints of individuals with RA showed a significant decrease in pain (p = 0.00) and improved range of motion (p = 0.001 bilaterally). JP was found to significantly improve grip strength (p = 0.001 bilaterally) and in the work (p = 0.01) and ADL (p = 0.01) sections of the MHQ. No significant difference was found between groups after intervention in the majority of outcomes (p = 0.24) except for grip strength where a significant difference was found (p = 0.001).

How kinematic disturbance in the deformed rheumatoid thumb impacts on hand function: a biomechanical and functional perspective

Purpose This study investigates the effects of kinematic disturbances in rheumatoid thumb on patient’s hand functions via objective and patient-perceived measurements. Method Twenty-one patients with rheumatoid arthritis (RA) and 21 healthy age- and gender-matched individuals were recruited to receive the objective evaluations, including the Purdue Pegboard Test, Jamar dynamometer, pinch-meter, Permanent Impairment Scale and self-administrated measurements, including the Health Assessment Questionnaire (HAQ) and Manual Ability Measure-36 (MAM-36). An electromagnetic tracking system was used to measure thumb kinematics. The differences in the measures between the RA and control groups and the dominant and non-dominant hands of the RA group were examined. The relationships between the thumb kinematics and hand functional capabilities, as well as impairment levels, were also explored. Results The RA group showed significantly smaller thumb movement capabilities and hand strength, as well as worse scores in hand dexterity, MAM-36 and HAQ than healthy controls. The movement workspace of the RA thumb showed moderate correlations with the factors of hand strength, dexterity, impairment scale, MAM-36 and HAQ scores. Conclusions The findings indicate deficits related to the movement capability of the RA thumb may negatively influence hand dexterity and functional hand performance, as well as life quality, for the patients with RA.Implications for RehabilitationA deformed rheumatoid thumb might limit the movement workspace of the thumb and consequently impair the hand performance as well as the life quality.The dominant thumb of the RA patients might have greater structural and functional deterioration than the non-dominant side.Suitable joint protection strategies, exercises and orthotics should be early applied to the RA patients for preserving hand functions.

Selective Inhibition of Membrane Type 1 Matrix Metalloproteinase Abrogates Progression of Experimental Inflammatory Arthritis: Synergy With Tumor Necrosis Factor Blockade.

ObjectiveIn rheumatoid arthritis (RA), destruction of articular cartilage by the inflamed synovium is considered to be driven by increased activities of proteolytic enzymes, including matrix metalloproteinases (MMPs). The purpose of this study was to investigate the therapeutic potential of selective inhibition of membrane type 1 MMP (MT1‐MMP) and its combination with tumor necrosis factor (TNF) blockage in mice with collagen‐induced arthritis (CIA).MethodsCIA was induced in DBA/1 mice by immunization with bovine type II collagen. From the onset of clinical arthritis, mice were treated with MT1‐MMP selective inhibitory antibody DX‐2400 and/or TNFR‐Fc fusion protein. Disease progression was monitored daily, and serum, lymph nodes, and affected paws were collected at the end of the study for cytokine and histologic analyses. For in vitro analysis, bone marrow–derived macrophages were stimulated with lipopolysaccharide for 24 hours in the presence of DX‐2400 and/or TNFR‐Fc to analyze cytokine production and phenotype.ResultsDX‐2400 treatment significantly reduced cartilage degradation and disease progression in mice with CIA. Importantly, when combined with TNF blockade, DX‐2400 acted synergistically, inducing long‐term benefit. DX‐2400 also inhibited the up‐regulation of interleukin‐12 (IL‐12)/IL‐23 p40 via polarization toward an M2 phenotype in bone marrow–derived macrophages. Increased production of IL‐17 induced by anti‐TNF, which correlated with an incomplete response to anti‐TNF, was abrogated by combined treatment with DX‐2400 in CIA.ConclusionTargeting MT1‐MMP provides a potential strategy for joint protection, and its combination with TNF blockade may be particularly beneficial in RA patients with an inadequate response to anti‐TNF therapy.

Co-Contraction of Knee Stabilizer Muscles during Sustained Squat Posture (A Yogic Posture) in Athletes

Simultaneous activation of muscles across a joint can be defined as muscle co-contraction. Its purpose is to augment the ligament function in maintenance of joint stability, provide resistance to rotation at a joint, and equalize the pressure distribution at the articular surface. The purpose of this study was to investigate the Co-contraction of selected knee stabilizer muscles as a measure of neuromuscular fatigue in relation to gender, performance and side (left and right) of male (n1=32) and female (n2=18) during sustained squat posture (yogic posture). Squat Posture was performed at an angle of 135o-150o because strength of knee stabilizers (muscles) varies from angle to angle and 135o to 150o is prominent angle range having high consideration for the performance of numerous physical daily routine activities such as walking, running, cycling, stepping and driving including development of fundamental skills for different sports across all ages and sex. Vastus Medialis (VM) and Vastus Lateralis (VL) muscles from the Quadriceps group were the knee stabilizers chosen for recording the EMG simultaneously from both right and left legs as these muscles are considered important for stabilization and protection of patellofemoral joint. The statistical analysis applied were ANOVA with post hoc analysis to determine the influence of fatigue in terms of gender, performance and side (left and right). The results showed significant female dominance behavior over males in coactivation of VM and VL muscles along with bilateral Asymetricity during sustained squat posture. The results of this study would help in better understanding the changes in knee stabilizers activation strategies that can help the clinicians and trainers in planning, execution of rehabilitation related to patellofemoral joint injuries.

Joint Knowledge Creation and Protection in Coopetitive Business Model

Collaboration between competitors - i.e. coopetition - delivers advantages for the generation of new business models that change and disrupt how value in and among firms is created and captured. In...

The Response of Rehabilitation Management in Patients Presenting with Locomotor Symptoms of Benign Joint Hypermobility Syndrome

AbstractThe benign joint hypermobility syndrome (BJHS) was first addressed by Kirk as a distinct pathology in 1967, as the presence of rheumatic symptoms with generalised joint laxity in the absence of any demonstrable systemic rheumatic disease.In this prospective, longitudinal, analytical study, we tried to find out the response of rehabilitation therapy in patients presenting with locomotor symptoms of BJHS and selected 61 patients randomly. The rehabilitation protocol followed: Explanation and reassurance, teaching of joint protection techniques and work modification, isometric muscle strengthening exercise (both extensor and flexor muscles), endurance exercise. Clinically most of the patients showed significant overall response quantitatively, in all the parameters.It can be concluded that the rehabilitation protocol prescribed here is very much suitable both quantitatively and qualitatively for the patients of BJHS.

Effects of Nordic walking on pelvis motion and muscle activities around the hip joints of adults with hip osteoarthritis.

[Purpose] Increased compensatory pelvic movement is remarkable in limping patients with hip osteoarthritis (OA). However, a method of improving limping has not been established. The purpose of this study was to identify the effects of two types of Nordic walking by analyzing the pelvic movement and muscle activities of adults with hip OA. [Subjects and Methods] Ten patients with OA of the hip performed Japanese-style Nordic walking (JS NW), European-style Nordic walking (ES NW), and Ordinary walking (OW), and the muscle activities around the hip joint and pelvic movements were analyzed. [Results] The pelvic rotation angle was significantly larger in ES NW than in JS NW. In the stance phase, hip abductor muscle activity was significantly decreased in JS NW compared to both OW and ES NW. In the swing phase, rectus abdominis muscle activity was significantly increased in both JS NW and ES NW compared to OW and lumbar erector spinae activity was significantly lower in JS NW than in OW. [Conclusion] JS NW style may reduce the compensatory pelvic rotation in patients with hip OA. JS NW might be better for joint protection and prevention of secondary disorders of the hip in OA patients.

Osteoarthritis of the Knee

Self-management (SM) programs for people with arthritis or other chronic diseases are commonplace and usually delivered by lay leaders. There is evidence indicating these programs are effective, although systematic reviews show these improvements are small. The self-management program for Osteoarthritis of the Knee (OAK) differs from other programs in a number of aspects. It is disease-specific and tailored for people with OAK. It was developed using an ENAT survey, a collaborative approach, and a Plan Do Study Act (PDSA) model. It was planned purposely for implementation in hospitals or community settings. The program is detailed for delivery by health professionals. In particular, exercise and disease coping strategies are promoted within a SM construct to improve quality of life and general health as well as reducing pain. The program was tested using an uncontrolled quality assurance study and the results were positive in pain, quality of life and physical function. A randomised controlled trial (RCT) was undertaken, where, the OAK group showed statistically significant improvements when compared with the control group with regard to pain, quality of life and function on the basis of WOMAC and SF-36 measurements taken 8 weeks and 6 months from baseline. The OAK program is conducted in a group setting over six weekly sessions of 2.5 hours. This allows participants to progress over time by incorporating and consolidating new information learned each week. In addition to the weekly sessions, handouts and reference book readings are given. For optimum group dynamics, the program is delivered by the same two health professionals to a group of 12-14 participants. The fidelity of the OAK program is maintained by the use of a scripted facilitators’ manual. Using a holistic approach, the program addresses multiple aspects of care: osteoarthritis (explanation and implications), SM skills (goal-setting, problem-solving, positive thinking and improving self-efficacy), medications (types, interactions and current trends), pain management strategies (cognitive and pharmacologic), fitness and exercise (strength, flexibility, aerobic), joint protection, nutrition and weight control, falls prevention (balance and proprioception), environmental risks, and coping skills. The OAK program has been sustained by development of health professional training workshops. OAK programs are delivered throughout Australia primarily by physiotherapists especially those working in district hospitals or primary care settings. To reduce costs, we have recently trialled programs using self-management trained peer leaders and health professionals which has worked extremely well.

Weaker Functional Pinch Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis.

The thumb carpometacarpal (CMC) joint orchestrates pinch in its various positions, and thumb CMC osteoarthritis (OA) is a major source of orthopaedic morbidity. Self-reported pain, weakness, and physical examination may not correspond to radiographic findings when diagnosing early thumb CMC OA. Weakness is a prominent feature of the disease, but little evidence exists to quantify self-reported loss of strength with time, or to compare weakness with that of a nonarthritic population during early disease. We asked: (1) Is pinch strength in subjects with early thumb CMC OA less than that in asymptomatic control subjects; and (2) weakness in which pinch position (key, tripod, or tip pinch) has the strongest association with early OA diagnosis? For this case-control study, we recruited 23 subjects who were asymptomatic and 91 with early OA for comprehensive history, physical examination, strength measurements, pain surveys, and radiographic evaluation. We used multivariate logistic regression to quantify the association between declining pinch strength and early OA diagnosis after controlling for age, sex, and BMI. This analysis was performed for three different pinch positions (key, tripod, and tip pinch) to evaluate which measurement was most closely associated with diagnosis. Pinch strength was less in patients with early thumb CMC OA. Key pinch had the most robust association with OA diagnosis, in which a 20% decrease in key pinch strength from the control subjects' baseline was associated with a 10% increase in the OA diagnosis (95% CI, 3%-16%; p = 0.004). This had a stronger association with OA diagnosis than tip pinch, in which a 20% decrease in strength was associated with a 6% increase in early CMC OA (95% CI, 1.0%-11%; p = 0.031). Tripod pinch also was associated to a lesser extent; a 20% reduction in tripod pinch led to a 5% increase in OA (95% CI, 1.3%-9%; p = 0.048). Decreasing pinch strength, especially key pinch, is associated with early CMC arthritis before the development of extensive radiographic disease. Weakness in pinch strength, especially key pinch, is an important feature in the pathogenesis of early CMC OA and may appear before radiographic disease is present or advanced. These findings suggest a role for intervention in early disease for promoting nonoperative joint protection and strengthening, and designing surgical procedures aimed to delay or prevent clinical and radiographic progression.

Fibronectin mediates enhanced wear protection of lubricin during shear.

Fibronectin (FN) is a glycoprotein found in the superficial zone of cartilage; however, its role in the lubrication and the wear protection of articular joints is unknown. In this work, we have investigated the molecular interactions between FN and various components of the synovial fluid such as lubricin (LUB), hyaluronan (HA), and serum albumin (SA), which are all believed to contribute to joint lubrication. Using a Surface Forces Apparatus, we have measured the normal (adhesion/repulsion) and lateral (friction) forces across layers of individual synovial fluid components physisorbed onto FN-coated mica substrates. Our chief findings are (i) FN strongly tethers LUB and HA to mica, as indicated by high and reversible long-range repulsive normal interactions between surfaces, and (ii) FN and LUB synergistically enhance wear protection of surfaces during shear, as suggested by the structural robustness of FN+LUB layers under pressures up to about 4 MPa. These findings provide new insights into the role of FN in the lubricating properties of synovial fluid components sheared between ideal substrates and represent a significant step forward in our understanding of cartilage damage involved in diseases such as osteoarthritis.

Differences in the Hand Force Requirements of Women With Hand Arthritis When Opening Jars With and Without Joint Protection Strategies

Abstract Date Presented 4/16/2015 Joint protection for hand osteoarthritis (OA) relies on theory but not empirical evidence. This study focuses on how hand positioning and nonskid materials influence forces, pain, and perceived effort during jar opening. New data challenge the belief that nonskid materials alone reduce hand forces.

Deletion of ADAMTS5 does not affect aggrecan or versican degradation but promotes glucose uptake and proteoglycan synthesis in murine adipose derived stromal cells

ADAMTS5 (TS5), a member of the aggrecanase clade (TS1, 4, 5, 8, 9, 15) of ADAMTS-proteases, has been considered largely responsible for the proteolysis of the hyalectans, aggrecan (Acan) and versican (Vcan), in vivo. However, we have reported that ts5-knockout (KO) mice show joint protection after injury due to inhibition of synovial scarring and enhanced Acan deposition. Also, KO mice have an impaired wound healing phenotype in skin and tendons which is associated with Acan/Vcan-rich deposits at the wound sites. Moreover, the Acan and Vcan deposited was aggrecanase-cleaved, even in the absence of TS5. In this study, we have used adipose-derived stromal cell (ADSC) and epiphyseal chondrocyte cultures from wild type and KO mice to further study the role of TS5 in Acan and Vcan turnover. We have confirmed with both cell types that the aggrecanase-mediated degradation of these hyalectans is not due to TS5, but an aggrecanase which primarily cleaves them before they are secreted. We also provide data which suggests that TS5 protein functions to suppress glucose uptake in ADSCs and thereby inhibits the synthesis, and promotes the intracellular degradation of Acan and Vcan by an ADAMTS other than TS5. We propose that this apparently non-proteolytic role of TS5 explains its anti-chondrogenic and pro-fibrotic effects in murine models of wound repair. A possible role for TS5 in an endocytotic process, involving competitive interactions between TS5, LRP1 and GLUT4 is discussed.

Anti-Inflammatory Effects and Joint Protection in Collagen-Induced Arthritis after Treatment with IQ-1S, a Selective c-Jun N-Terminal Kinase Inhibitor.

c-Jun N-terminal kinases (JNKs) participate in many physiologic and pathologic processes, including inflammatory diseases. We recently synthesized the sodium salt of IQ-1S (11H-indeno[1,2-b]quinoxalin-11-one oxime) and demonstrated that it is a high-affinity JNK inhibitor and inhibits murine delayed-type hypersensitivity. Here we show that IQ-1S is highly specific for JNK and that its neutral form is the most abundant species at physiologic pH. Molecular docking of the IQ-1S syn isomer into the JNK1 binding site gave the best pose, which corresponded to the position of cocrystallized JNK inhibitor SP600125 (1,9-pyrazoloanthrone). Evaluation of the therapeutic potential of IQ-1S showed that it inhibited matrix metalloproteinase 1 and 3 gene expression induced by interleukin-1β in human fibroblast-like synoviocytes and significantly attenuated development of murine collagen-induced arthritis (CIA). Treatment with IQ-1S either before or after induction of CIA resulted in decreased clinical scores, and joint sections from IQ-1S-treated CIA mice exhibited only mild signs of inflammation and minimal cartilage loss compared with those from control mice. Collagen II-specific antibody responses were also reduced by IQ-1S treatment. By contrast, the inactive ketone derivative 11H-indeno[1,2-b]quinoxalin-11-one had no effect on CIA clinical scores or collagen II-specific antibody titers. IQ-1S treatment also suppressed proinflammatory cytokine and chemokine levels in joints and lymph node cells. Finally, treatment with IQ-1S increased the number of Foxp3(+)CD4(+)CD25(+) regulatory T cells in lymph nodes. Thus, IQ-1S can reduce inflammation and cartilage loss associated with CIA and can serve as a small-molecule modulator for mechanistic studies of JNK function in rheumatoid arthritis.

Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation.

The effectiveness of exercise for improving hand and wrist function in people with rheumatoid arthritis (RA) is uncertain. The study aims were (1) to estimate the clinical effectiveness and cost-effectiveness of adding an optimised exercise programme for hands and upper limbs to standard care for patients with RA; and (2) to qualitatively describe the experience of participants in the trial with a particular emphasis on acceptability of the intervention, exercise behaviours and reasons for adherence/non-adherence. A pragmatic, multicentred, individually randomised controlled trial with an embedded qualitative study. Outcome assessors were blind to group assignment and independent of treatment delivery. Seventeen NHS trusts in England comprising 21 rheumatology and therapy departments. Adults with RA who had pain and dysfunction of the hands and/or wrists and had been on stable medication for at least 3 months. Patients were excluded if they were under 18 years old, had undergone upper limb surgery/fracture in the last 6 months, were on a waiting list for upper limb surgery or were pregnant. Usual care or usual care plus an individualised exercise programme. Usual care consisted of joint protection education, general exercise advice and functional splinting if required. The exercise programme consisted of six sessions of strengthening and stretching exercises with a hand therapist, daily home exercises and strategies to maximise adherence. The primary outcome was the Michigan Hand Outcome Questionnaire (MHQ) overall hand function subscale score at 12 months. Secondary outcome measures included the full MHQ, pain, health-related quality of life (Short Form questionnaire-12 items), impairment (grip strength, dexterity and range of motion) and self-efficacy. European Quality of Life-5 Dimensions, medication and health-care use were collected for the health economics evaluation. Follow-up was at 4 and 12 months post randomisation. Analysis was performed on an intention-to-treat basis. We randomised 490 patients (244 to usual care, 246 to exercise programme). Compliance with the treatments was very good (93% of usual care participants and 75% of exercise programme participants completed treatment). Outcomes were obtained for 89% of participants at 12 months (222 for usual care, 216 for exercise programme). There was a statistically significant difference in favour of the exercise programme for the primary outcome at 4 and 12 months [mean difference 4.6 points, 95% confidence interval (CI) 2.2 to 7.0 points; and mean difference 4.4 points, 95% CI 1.6 to 7.1 points, respectively]. There were no significant differences in pain scores or adverse events. The estimated difference in mean quality-adjusted life-years (QALYs) accrued over 12 months was 0.01 greater (95% CI -0.03 to 0.05) in the exercise programme group. Imputed analysis produced incremental cost-effectiveness ratio estimates of £17,941 (0.59 probability of cost-effectiveness at willingness-to-pay threshold of £30,000 per QALY). The qualitative study found the exercise programme to be acceptable and highlighted the importance of the therapist in enabling patients to establish a routine and incorporate the exercises into their lives. The results of the Strengthening And stretching for Rheumatoid Arthritis of the Hand trial suggest that the addition of an exercise programme for RA hands/wrists to usual care is clinically effective and cost-effective when compared with usual care alone. No adverse effects were associated with the exercise programme. The economic analysis suggests that the intervention is likely to be cost-effective. Current Controlled Trials ISRCTN 89936343.