This article considers the evidence for effectiveness and timing of rehabilitation for people with
rheumatoid arthritis (RA). The Cochrane Library, DARE, Medline, Embase, CINAHL and AMED were searched to identify systematic reviews and randomized controlled trials evaluating rehabilitation interventions for people with
rheumatoid arthritis. Many trials identified had methodological limitations (e.g. short follow-up periods, small sample sizes). Evidence to date is that symptomatic relief results from
thermotherapy,
laser therapy, acupuncture and
assistive devices. In the short-term, comprehensive
occupational therapy (in established
rheumatoid arthritis),
orthoses, and mind-body approaches can help maintain function. Over at least a one-year period, the following are effective in reducing
pain and maintaining function: patient education and joint protection training using behavioural approaches; dynamic
exercise therapy, hand exercises and
hydrotherapy; and cognitive-behavioural
therapy (in people with poorer psychological status). Many trials have recruited people with moderate to severe, established RA and relatively little is known about the long-term effectiveness of early rehabilitation, although this is becoming much more common in practice. Despite the increased availability of guidelines and systematic reviews, most conclude there is insufficient evidence for many areas of rheumatology rehabilitation. Further well-designed clinical trials are needed recruiting people with early disease using patient-centred outcomes.