تأثیر یک روش درمانی غیر تهاجمی بر درد سالمندان مبتلا به آرتریت روماتوئیـد

Introduction
Rheumatoid arthritis (RA) is a chronic, systemic autoimmune inflammatory disorder whose prevalence increases with advancing age and is associated with substantial functional impairment in older adults. According to reports from the World Health Organization, rheumatic diseases are among the leading causes of disability in the elderly population. Given the chronic nature of RA and the prolonged use of specific pharmacologic agents, long-term treatment may impose economic burdens and increase the risk of adverse effects, particularly in older individuals. Consequently, medical sciences have consistently sought safe, low-risk, and cost-effective complementary therapeutic approaches. The present study aimed to investigate the effects of sauna and massage therapy as a non-invasive therapeutic complex on pain in elderly patients with RA. Massage therapy, as a complementary non-pharmacological intervention, has been shown to reduce pain and joint stiffness in RA patients. Recommendations published by the American College of Rheumatology support the use of adjunctive non-pharmacologic interventions alongside standard medical treatment to improve symptom control. Evidence suggests that massage may reduce pain perception through enhanced local blood circulation, decreased muscle tension, and stimulation of parasympathetic activity. In elderly patients, gentle massage may also alleviate periarticular muscle spasm and improve joint range of motion (ROM).

Methods
In this quasi-experimental study, 120 elderly individuals with RA who were referred to medical centers in Tehran were recruited voluntarily. Participants were randomly allocated into three groups (n=40 each): two intervention groups and one control group. All groups were followed over a two-month period. Pain intensity was assessed at baseline, mid-intervention, and at the end of the study period. The control group received no sauna or massage intervention. Intervention group 1 received sauna followed by massage twice weekly, whereas intervention group 2 received the same intervention three times weekly. To evaluate the effects of sauna and massage on joint mobility, anthropometric measurement techniques were employed to assess ROM in affected joints. Participants were instructed not to alter the dosage of their prescribed anti-rheumatic medications during the study and to continue their treatment as directed by their physicians. Data collection tools included questionnaires, observation forms, and the Visual Analog Scale (VAS). Pain intensity was measured using the Visual Analog Scale (VAS) at baseline, mid-intervention, and post-intervention.

Results
Data were analyzed using descriptive and inferential statistics. The chi-square test was applied to examine associations between pain severity and categorical variables such as medication regimen, age, and occupation. One-way analysis of variance (ANOVA) was used to compare pain intensity across the three measurement time points (before, immediately after, and one day after the intervention). Independent t-tests were used to compare mean pain scores between groups, and paired t-tests were used to assess within-group changes in pain intensity. Statistical significance was set at α = 0.05.

The findings demonstrated a statistically significant reduction in pain intensity (approximately 50%) in both intervention groups compared with the control group (P < 0.05). Approximately 75% of participants reported pain relief and improved joint mobility following sauna and massage therapy. Notably, the reduction in pain intensity remained significantly sustained up to one day post-intervention.

Conclusion
Considering the chronic nature of pain in RA patients and the potential adverse effects associated with long-term pharmacotherapy, alongside the low cost and safety profile of sauna and massage as non-invasive interventions, the findings suggest that this therapeutic combination may effectively reduce pain and enhance joint mobility in elderly patients with RA. Improved mobility may further facilitate daily and social functioning. Therefore, sauna and massage may be recommended as a safe, non-invasive adjunct or alternative to pharmacological therapy for pain management in elderly individuals with rheumatoid arthritis.

Footnotes

Funding: This study received no financial support.

Conflict of interest: The author declares no conflict of interest.

Acknowledgments: I would like to express my sincere gratitude to all those who assisted me throughout the research process.