What information should be stressed to a patient diagnosed with Rheumatoid Arthritis (RA) regarding wrist splinting?

From the Guidelines

Patients with rheumatoid arthritis should be advised that wrist splints can effectively reduce pain and inflammation during disease flares by immobilizing the joint and providing rest. The most recent and highest quality study, 1, provides guidance on rehabilitation interventions for the management of rheumatoid arthritis, including the use of splinting, orthoses, and/or compression for patients with hand and/or wrist involvement and/or deformity. Key points to emphasize to patients include:

• Splints should be worn primarily during periods of increased pain or inflammation, and especially at night to prevent painful positioning during sleep.
• Daytime use is recommended during activities that aggravate symptoms, but continuous 24-hour wear should be avoided as this can lead to muscle weakness and joint stiffness.
• The splint should position the wrist in a neutral or slightly extended position to maximize function while providing support.
• Patients should ensure the splint fits properly—snug enough to provide support but not so tight that it restricts circulation or causes discomfort.
• Regular removal for gentle range-of-motion exercises is important to prevent stiffness and maintain muscle strength.
• Patients should clean their splints regularly according to manufacturer instructions to maintain hygiene and extend the splint's lifespan.
• Splinting should be considered one component of a comprehensive RA management plan that includes medication, exercise, and joint protection techniques, not as a replacement for these interventions. In terms of specific options provided:
• a. Splinting will help minimize the wrist pain: This is a correct statement, as splinting can help reduce pain and inflammation during disease flares.
• b. The actual splint should be removed at least once daily: This is also a correct statement, as regular removal for gentle range-of-motion exercises is important to prevent stiffness and maintain muscle strength.
• c. Splinting should be instituted as soon as minor deformity is observed: This statement is not directly supported by the evidence, but splinting is recommended for patients with hand and/or wrist involvement and/or deformity.
• d. The splint should be used when exercising the wrist joint: This statement is not necessarily correct, as splints are typically recommended for use during periods of increased pain or inflammation, or during activities that aggravate symptoms, rather than during exercise.
• e. Wrist deformity is diminished when splinting is applied: This statement is not directly supported by the evidence, but splinting can help reduce pain and inflammation, and may help prevent further deformity.

From the Research

Information to be Stressed to a Patient with Rheumatoid Arthritis (RA) Regarding Wrist Splinting

• The following points should be emphasized:
  • Splinting will help minimize the wrist pain: Studies have shown that wrist splinting can reduce pain in patients with RA 2, 3.
  • The actual splint should be removed at least once daily: Although not directly stated in the provided studies, regular removal of the splint is a common recommendation for maintaining skin health and preventing complications.
  • Splinting should be instituted as soon as minor deformity is observed: Early intervention with splinting may help prevent further deformity and improve hand function 4.
  • The splint should be used when exercising the wrist joint: Wearing a splint during activities that require greater strength than dexterity can provide support and relief 5.
  • Wrist deformity is diminished when splinting is applied: While the studies do not provide direct evidence for this statement, splinting can help prevent further deformity and improve hand function 4, 3.

Key Findings from Relevant Studies

• A study published in 2018 found that wrist stabilisation improves hand function in patients with RA, particularly those with moderate and high disease activity 4.
• A 2001 systematic review found insufficient evidence to make firm conclusions about the effectiveness of working wrist splints in decreasing pain or increasing function for people with RA, but noted that extra-depth shoes and molded insoles can decrease pain on weight-bearing activities 6.
• A 2008 randomized controlled study found that prefabricated wrist working splints are highly effective in reducing wrist pain after 4 weeks of splint wearing in RA patients with wrist arthritis 2.
• A 2014 mixed methods systematic review found strong quantitative evidence that working wrist splints reduce pain and improve grip strength in rheumatoid arthritis, but insufficient evidence of their effect on function 3.
• A 1982 study found that patients with RA reported wearing their splints more frequently for activities requiring greater strength than dexterity, and reported pain relief from wearing their splints 5.