Indian Journal of Rheumatology

: 2017  |  Volume : 12  |  Issue : 2  |  Page : 70--71

Enhancing hand function in rheumatoid arthritis: An artistic ploy

Subramanian Shankar 
 Department of Medicine and Clinical Immunology, Command Hospital Air Force, Bengaluru, Karnataka, India

Correspondence Address:
Subramanian Shankar
Department of Medicine and Clinical Immunology, Command Hospital Air Force, Bengaluru, Karnataka

How to cite this article:
Shankar S. Enhancing hand function in rheumatoid arthritis: An artistic ploy.Indian J Rheumatol 2017;12:70-71

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Shankar S. Enhancing hand function in rheumatoid arthritis: An artistic ploy. Indian J Rheumatol [serial online] 2017 [cited 2023 Feb 1 ];12:70-71
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Exercises form an important aspect of nonpharmacological measures in the management of rheumatoid arthritis (RA) and are useful in maintaining joint functions and preventing contractures and muscle atrophy.[1] Regular aerobic exercises (such as walking, swimming, cycling, and supervised cardiorespiratory aerobic conditioning) improve muscle function, joint stability, aerobic capacity, and physical performance over the short term and can result in improved overall pain control and quality of life, without an increase in disease activity. As a result, it is important that patients should exercise regularly. Exercises however do happen to sometimes be boring being repetitive and often the adherence to the same is suboptimal. Hence, exploring other options, especially with regard to hand functions, forms an interesting area of study.

Scientists have looked at the role of therapies that involve coordinated actions of multiple groups of muscles in a coordinated way rather than simple exercises that focus on just one set of muscle groups. A Cochrane meta-analysis looked at the role of Tai Chi (Chinese martial art) in RA and suggested that it does not exacerbate symptoms and had statistically significant benefits on lower extremity range of motion, in particular range of motion at ankles.[2] There are anecdotal reports of folk art and painting having beneficial effects on hand functions in RA. The most famous case is that of Grandma Moses (1860–1961) who developed RA at the age of 70 and painted over 1600 pieces of art over the next 30 years helping her retain her hand function, much before the era of disease-modifying antirheumatic drugs.[3]

A recent study from Japan looked at the role of ceramic art in hand functions in RA and concluded that it is an activity capable of improving the physical condition and mental state (alleviation of depression, etc.) of patients with RA and improving physical functions such as grip and dominant pinching power, showing it as an effective means of rehabilitation.[4]

In the current issue of IJR, Khedekar et al. evaluated the efficacy of various forms of art as a creative therapeutic procedure for enhancement of hand functions, self-perception, and quality of life in patients with RA.[5] They compared art-based intervention with bimanual projects (viz., origami, paper quelling, clay modeling, and oil painting) with conventional physiotherapy and showed that art might be an equally effective therapeutic intervention to conventional therapy for the domains measured. There are several limitations to the study, the most important one being a very limited sample size and the high dropout rate. However, the idea holds an interesting appeal and merits further exploration.

Picking up a glass of water does not seem to be a difficult task. Yet, this simple task obscures the complex tasks our motor system has to solve when organizing this action. For the prehension movement to the glass, the reach has to be coordinated with the grasping component to bring the hand in the proper configuration to the right place. When one lifts the glass, the load and grip forces applied by the fingers have to be coordinated to account for the weight of the glass, its fragility, and possible slippage. The action structure is different, whether we want to simply drink, to clink glasses, or to give the glass to somebody else.[6]

Taking up an artistic pursuit of any form involves a complex range of motor movement of hands and is likely to provide exercise to various groups of muscles in a coordinated pattern. It also holds the promise of being entertaining with likely beneficial effects on mental well-being. Interspersing conventional exercises with various art forms of therapy thus needs further research. However, it is important that the team conducting such therapies should take special care because the focus should not be around a useful or specific item based on an artistic production rule; instead, the goal should be oriented to the production process itself. To work with various artistic forms in an environment that does not demand a complete mastering of artistic techniques may produce a beneficial effect in people with RA.


1Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, Schoones J, Van den Ende EC. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. In: Hurkmans E, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley and Sons, Ltd.; 2009.
2Han A, Robinson V, Judd M, Taixiang W, Wells G, Tugwell P. Tai chi for treating rheumatoid arthritis. Cochrane Database Syst Rev 2004;(3):CD004849.
3Azevedo VF. Working with folk arts may produce benefits to rheumatic patients: The case of Grandma Moses. Rheumatology (Oxford) 2008;47:1250.
4Tanaka R, Tsuchida T. AB1061 Is ceramic art useful in treatment of rheumatoid arthritis? Ann Rheum Dis 2016;75 Suppl 2:1264-5.
5Khedekar S, Shimpi A, Shyam A, Sancheti P. Use of art as therapeutic intervention for enhancement of hand function in patients with rheumatoid arthritis: A pilot study. Indian J Rheumatol 2017;12:94-6.
6Weiss P, Jeannerod M. Getting a grasp on coordination. News Physiol Sci 1998;13:70-5.