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Rheumatoid Arthritis Treatment

What is the SARAH program?

The SARAH program is a set of exercises which has been clinically proven to improve strength and hand function in people with Rheumatoid Arthritis.  The 12 week program is delivered in 6 supervised hand therapy sessions.

The SARAH certified therapist and client work together to set individualised goals and select appropriate exercises which are pain-free but sufficiently challenging for the client.  The client is taught how to progress or regress their exercises according to their symptoms, and is assisted to establish a daily exercise routine with the help of personalised exercise guides and exercise diaries.

The SARAH program is supplemented with traditional Rheumatoid Arthritis care including education on joint protection principles and provision of splints and assistive devices where appropriate.

Why is exercise necessary?
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Studies have shown that within 6 months of diagnosis, people with RA have an average of less than 40 percent of normal power and pinch grip compared to the non-RA population.  Although medications can effectively counteract the disease activity, they don't help in the recovery of lost muscle mass or strength, therefore the SARAH program includes strengthening exercises to improve muscle strength and hand function.

People with Rheumatoid Arthritis also often experience restricted movement in their hands, wrists, elbows and shoulders, so the SARAH program includes simple exercises to maintain the mobility of all the joints in the upper limb.

Proven Outcomes

Recent studies have compared patients receiving the SARAH program to patients receiving standard care.  The group that received the SARAH program had double the improvement in hand function compared to the group receiving standard care.

The study found no adverse effects from the SARAH program such as increased pain or flare-ups.

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References

  1. Heine PJ, Williams MA, Williamson E, Bridle C, Adams J, O’Brien A, Evans D, Lamb SE. Development and delivery of an exercise intervention for rheumatoid arthritis: strengthening and stretching for rheumatoid arthritis of the hand (SARAH) trial. Physiotherapy. 2012 Jun 1; 98(2):121-30.

  2. Adams J, Bridle C, Dosanjh S, Heine P, Lamb SE, Lord J, McConkey C, Nichols V, Toye F, Underwood MR, Williams MA. Strengthening and stretching for rheumatoid arthritis of the hand (SARAH): design of a randomised controlled trial of a hand and upper limb exercise intervention-ISRCTN89936343. BMC musculoskeletal disorders. 2012 Dec;13(1):1-0.

  3. Lamb SE, Williamson EM, Heine PJ, Adams J, Dosanjh S, Dritsaki M, Glover MJ, Lord J, McConkey C, Nichols V, Rahman A. Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial. The Lancet. 2015 Jan 31;385(9966):421-9. Nichols VP, Williamson E, Toye F, Lamb SE. A longitudinal, qualitative study exploring sustained adherence to a hand exercise programme for rheumatoid arthritis evaluated in the SARAH trial. Disability and rehabilitation. 2017 Aug 28; 39(18):1856-63.

  4. Nichols VP, Williamson E, Toye F, Lamb SE. A longitudinal, qualitative study exploring sustained adherence to a hand exercise programme for rheumatoid arthritis evaluated in the SARAH trial. Disability and rehabilitation. 2017 Aug 28; 39(18):1856-63.

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