title: Neuromuscular electrical stimulation and volitional exercise for individuals with rheumatoid arthritis: a multiple-patient case report.
abstract: OBJECTIVE
  Muscle atrophy is common in patients with rheumatoid arthritis (RA). Although neuromuscular electrical stimulation (NMES) is a viable treatment for muscle atrophy, there is no evidence about the use of NMES in patients with RA. The purposes of this multiple-patient case report are: (1) to describe the use of NMES applied to the quadriceps femoris muscles in conjunction with an exercise program in patients with RA; (2) to report on patient tolerance and changes in lean muscle mass, quadriceps femoris muscle strength (force-producing capacity), and physical function; and (3) to explore how changes in muscle mass relate to changes in quadriceps femoris muscle strength, measures of physical function, and patient adherence.
  
  
  METHODS
  Seven patients with RA (median age=61 years, range=39-80 years) underwent 16 weeks of NMES and volitional exercises. Lean muscle mass and strength of the quadriceps femoris muscle and physical function were measured before and after treatment.
  
  
  RESULTS
  One patient did not tolerate the NMES treatment, and 2 patients did not complete at least half of the proposed treatment. Patients who completed the NMES and volitional exercise program increased their lean muscle mass, muscle strength, and physical function.
  
  
  CONCLUSIONS
  Because of the small sample, whether NMES combined with exercises is better than exercise alone or NMES alone could not be determined. However, the outcomes from this multiple-patient case report indicate that NMES is a viable treatment option to address muscle atrophy and weakness in patients with RA. Strategies to increase tolerance and adherence to NMES are warranted.
authors.affiliation: Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA. spiva@pitt.edu
authors.forename: Sara R
authors.initials: SR
authors.lastname: Piva
authors.forename: Edward A
authors.initials: EA
authors.lastname: Goodnite
authors.forename: Koichiro
authors.initials: K
authors.lastname: Azuma
authors.forename: Jason D
authors.initials: JD
authors.lastname: Woollard
authors.forename: Bret H
authors.initials: BH
authors.lastname: Goodpaster
authors.forename: Mary Chester
authors.initials: MC
authors.lastname: Wasko
authors.forename: G Kelley
authors.initials: GK
authors.lastname: Fitzgerald
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications*; D002100:Cachexia / Q000209:etiology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D015444:Exercise; D006801:Humans; D008875:Middle Aged; D052097:Quadriceps Muscle