Effects of physiotherapy interventions on the management of rheumatoid arthritis: An integrative literature review

Abstract

Introduction: Rheumatoid arthritis is a chronic, systemic inflammatory disease that can cause pain, joint stiffness, reduced muscle strength, fatigue, and impairment of functional capacity and quality of life. In this context, physical therapy and therapeutic exercise constitute relevant non-pharmacological strategies to minimize the physical and functional impacts of the disease. Objective: To synthesize available evidence regarding the effects of physical therapy interventions on the management of rheumatoid arthritis, considering their impact on pain, muscle strength, aerobic capacity, functional capacity, fatigue, disease activity, and quality of life. Methods: This is an integrative literature review of a qualitative and descriptive nature. The search was conducted in the PubMed/MEDLINE, SciELO, and BVS databases using descriptors and terms related to rheumatoid arthritis, physical therapy, rehabilitation, and therapeutic exercise. Studies investigating physical therapy interventions and their effects on clinical and functional outcomes in individuals with rheumatoid arthritis were included. Following the identification, screening, and eligibility stages, 10 studies comprised the final sample. Results: The analyzed studies covered aerobic exercise, resistance training, combined exercise, hydrotherapy, manual therapy, electrotherapy, and other rehabilitation strategies. Overall, favorable effects were observed, particularly regarding pain, functional capacity, muscle strength, aerobic conditioning, fatigue, hand function, well-being, and quality of life. Aerobic exercise showed benefits for functional capacity, pain, and aerobic fitness, although its effects on disease activity and inflammatory markers were less consistent. Hydrotherapy demonstrated favorable results, especially regarding pain, joint tenderness, and perceived well-being, while greater muscle strength was associated with reduced functional disability. However, the heterogeneity of the interventions and the low certainty of some of the evidence limit the determination of a superior therapeutic modality. Conclusion: Physiotherapeutic interventions show favorable effects in the management of rheumatoid arthritis, particularly regarding symptoms and physical and functional aspects. The findings reinforce the importance of individualized exercise and rehabilitation programs that take into account each patient's clinical condition, functional limitations, and needs. Further studies using more standardized protocols and long-term follow-up are needed to strengthen the evidence regarding the effectiveness of different physiotherapy modalities.