Introduction
Hand pain and functional problems are common and a leading cause of disabilities in everyday activities, leisure and work in people with RA [1]. Nine out of 10 adults with RA report pain, stiffness, muscle weakness, paraesthesia and difficulty making a fist [2]. These symptoms can persist and deteriorate even when disease activity is controlled with DMARDs [3, 4], which are prescribed to achieve remission or lower disease activity and prevent radiographic progression of the disease. DMARDs are also prescribed to those with persistent synovitis who have not yet met the diagnostic criteria for RA [i.e. undifferentiated inflammatory arthritis (UIA)] [5].
Pain from RA is historically thought to be a direct result of peripheral inflammation [6], but later studies have shown discordance between clinicians’ assessments of inflammation and patient-reported pain [7, 8]. Knowledge and understanding of pain mechanisms in RA have since developed into describing this process as an interplay between joint pathology and the processing of pain signals by peripheral, spinal and supraspinal pain pathways [9]. Peripheral pain mechanisms include the direct activation of nociceptors, in addition to sensitization of nociceptors by joint inflammation [10, 11]. Like peripheral sensitization, central causes of pain arise as a result of abnormalities in the CNS and dysregulation of the CNS pain pathways, leading to chronic pain [12, 13]. These mechanisms might explain, in part, why a significant proportion of patients with RA remain symptomatic even with biological and targeted synthetic DMARDs (b/tsDMARDs) [13].
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Arthritis gloves are widely prescribed in rheumatology departments by occupational therapists to people with RA and UIA presenting with hand pain and problems: for daytime wear to reduce hand pain and improve hand function and/or for night-time wear to reduce pain, improve sleep and reduce morning stiffness [14, 15]. The mechanism by which arthritis gloves impact on hand symptoms is thought to be through compression, which removes extracellular fluid (e.g. swelling), thus reducing pain and stiffness and improving finger movement [16, 17]. Different makes of glove apply differing amounts of pressure. Systematic review evidence was inconclusive about the effectiveness of arthritis gloves [15].
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We have previously reported results from a randomized controlled trial (RCT) in adults (≥18 years of age) with RA or UIA in the UK, investigating the clinical and cost-effectiveness of arthritis gloves compared with placebo gloves on hand pain, stiffness and function [1, 18]. Participants in the intervention group received correctly fitted three-quarter-length finger Isotoner gloves [19]. Participants in the control group received loose-fitting three-quarter-length finger Jobskin classic oedema gloves [20]. The placebo gloves for the control group were chosen by a panel of experts including occupational therapists, researchers and patient research partners to ensure their credibility. In the trial, they were fitted at least one size too large and exerted no or minimal pressure to ensure they did not apply therapeutic levels of compression [Fig. 1]. When fitting gloves, occupational therapists measured participants’ MCP joint circumference to determine the glove size required and used their clinical judgement to determine appropriate fit, following the A-GLOVES Occupational Therapy Glove Provision Manual [1, 21]. Therapists attended theoretical and practical training in intervention and placebo glove fitting, in order to standardize treatment delivery [22]. All participants received the same verbal and written information about glove wear and care, with the glove wear regimen individualized to suit their needs (i.e. wearing gloves in the day, night or both). All received written information about hand self-management (joint protection and exercise). Occupational therapists reviewed glove fit 2-4 weeks later or asked participants to contact them if experiencing problems. Given that gloves are intended to be worn long term, a 12-week follow-up was selected to allow several weeks for glove tolerance to develop and for participants to experience the effects of regular wear for ≤2 months across a range of activities [18].
This nested qualitative study aimed to explore participants’ views on the impact of wearing arthritis gloves on their hand pain and function to provide an insight into their lived experience and to gain a greater understanding of the contextual and person-related factors affecting arthritis glove wearing.
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