Effect of Different Physiotherapeutic Interventions in Patients With Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.

BACKGROUND

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder causing joint damage, pain, and functional limitations. While pharmacotherapy remains central to management, physiotherapeutic interventions are increasingly recognised for their supportive role in symptom alleviation and quality of life enhancement.

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the effectiveness of various physiotherapeutic interventions in reducing pain and improving function and quality of life in patients with RA.

METHODS

Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, and Web of Science (2010-2025) identified randomized controlled trials (RCTs) assessing physiotherapy modalities in RA. Methodological quality was appraised using the Cochrane RoB 2.0 tool. Pain outcomes were synthesised via meta-analysis using a random-effects model.

RESULTS

Seventeen RCTs involving 1362 participants were included. Interventions encompassed aerobic/resistance exercise, hydrotherapy, manual therapy, electrotherapy, and multimodal approaches. Meta-analysis of five trials (n = 307) revealed a statistically significant reduction in pain favouring physiotherapy (SMD = -0.347; 95% CI: -0.571 to -0.124; p = 0.002; I* = 0%). No significant publication bias was detected. Narrative synthesis indicated potential benefits in functional and cardiorespiratory outcomes, especially with combined exercise and lifestyle interventions.

CONCLUSIONS

Physiotherapeutic interventions, particularly structured exercise programs, demonstrate moderate evidence for pain reduction in RA. Integrating multimodal physiotherapy with diet and adjunct therapies may enhance patient outcomes. Further high-quality, standardized RCTs are warranted to optimise intervention protocols and assess long-term benefits.