Evidence
[Narrator] Hello, I'm Alison Hammond and I'm a Professor of Rheumatology Rehabilitation at the University of Salford.

People with arthritis have hand pain, often causing problems doing everyday activities and work. Arthritis gloves are often provided on the NHS, or people buy them themselves. They are thin, fingerless, nylon and lycra gloves, which apply pressure to the hands and also keep them warm.

These may help reduce hand pain, and they can be worn during the daytime or at night, when hands are painful. But we found there was very little research evidence that they work, so we ran a randomised controlled trial to test the arthritis gloves, funded by the National Institute of Health Research.

Over 200 people with arthritis took part. Half got the arthritis gloves applying pressure and warmth, and the other half got gloves that are a looser fit, so no pressure, but the same amount of warmth.

We questioned people before, and again three months later, about the effects of the gloves. Both gloves had similar effects: pain and stiffness reduced a little, and being able to use the hands improved a little. But there was no real difference between the two types of glove. Most people who had either sort of glove thought they helped, but it was the warmth from the gloves that they most often said was what helped them.

So what's the impact of this? We recommend that rather than using special arthritis gloves, which can cost up to £25 a pair, that people with arthritis could try using an ordinary, lightweight, thin, fingerless glove, including 3 - 5% lycra, which are a close fit. Gloves like this give some feeling of support, comfort, and provide warmth when people need it. These will be cheaper for people to buy themselves, and the NHS will also save money, as we now know that the arthritis gloves are not value for money.

Thank you.

[Text on screen] Alison Hammond, Professor of Rheumatology Rehabilitation
University of Salford Manchester

Special arthritis gloves are no better at reducing pain and stiffness than looser-fitting gloves

Special arthritis gloves are no more effective than looser-fitting alternatives in reducing hand pain and stiffness, new work has shown. The researchers say that healthcare professionals should not recommend special gloves; the cheaper alternatives are just as effective. 

Rheumatoid arthritis is a common condition which causes painful joints. Special gloves can be prescribed for hand pain; they are usually given out by occupational therapists. However, there is no strict guidance on when gloves should be given. 

When the researchers reviewed the available research, they found little evidence that the gloves are effective in reducing hand pain and stiffness. They then set up a large trial and found that the special gloves were no more effective than looser-fitting alternatives. 

The researchers say that healthcare professionals should not recommend special gloves, and the NHS should stop buying them. The main benefit of gloves was warmth; and ordinary gloves could be just as effective. The results suggest that professionals should advise people to try ordinary fingerless gloves or buy their own gloves from high street shops or online. 

Further information can be found about arthritis on the NHS website.

What’s the issue?

Rheumatoid arthritis causes pain and inflammation at the joints, and can restrict movement. Around 400,000 people in the UK live with the condition. Most are over 40 but children and young people can also have rheumatoid arthritis.

Undifferentiated arthritis is an umbrella term for arthritis that does not fit a specific diagnosis, often because it developed recently. For many people, symptoms resolve without treatment. But 1 in 3 go on to develop rheumatoid arthritis. 

Treatments typically include medication, physiotherapy, occupational therapy and surgery. In addition, since the 1980s, special gloves have been widely prescribed for rheumatoid arthritis and other common types of arthritis.

Special gloves are believed to work by exerting pressure and so help reduce swelling. This is thought to reduce pain and stiffness. The gloves are prescribed for daytime wear to improve function and for night-time use to improve sleep. 

The gloves are considered low cost at up to £25 per pair. The NHS usually provides people with one pair only, which need to be replaced after 4 – 6 months. Many people therefore need to buy the gloves themselves after that, and the cost mounts up. 

Despite their widespread use, there is little evidence to show that they are effective. One small study found that people generally liked the comfort, warmth and gentle support the special gloves gave. It showed some small improvements in hand pain, stiffness and function. However, there was no comparison group which meant there was no way to tell whether the gloves or other aspects of care led to improvements.

In the current study, researchers discussed what type of gloves should serve as a comparison. People with arthritis were involved in the design of the study. They said the alternatives should be loosely fitted and apply no pressure but still provide similar warmth. 

What’s new?

The study included 163 people with rheumatoid arthritis or undifferentiated arthritis. They were aged 59 years on average and were being treated at 16 NHS sites in England and Scotland. 

Everyone in the study received three-quarter-length gloves that leave fingers free. They were either special arthritis gloves that apply pressure, or loose-fitting alternatives. Both types kept hands warm and both were fitted by occupational therapists.

Participants completed a survey before they received the gloves and again 12 weeks later, after the trial. They rated pain in their dominant hand during activities such as housework, DIY and gardening. They also gave their opinion about the gloves. 

People in both groups reported similar, but only small, improvements in hand pain. Most people (73%) in both groups found the gloves beneficial. 

Study participants said that:

    • gloves give warmth (74% with arthritis gloves; 80% with the alternatives)
    • gloves give comfort (85% with arthritis gloves; 75% with the alternatives)
    • gloves improve sleep (41% of people in both groups).

Both groups expressed had similar views about the gloves. A participant with loose-fitting gloves said: “They were fab.  They actually made my joints warm and… as soon as your joints get a bit warmer, the pain actually eases”. Most people (72%) in both groups said they would continue to wear them. 

The most common problem in both groups was sleep disturbance, when gloves made hands hot and itchy. More people wearing the arthritis gloves reported downsides (51% compared to 36% with the alternatives). People wearing specialist gloves were more likely to have pins and needles, or numbness.  Similar numbers in both groups stopped using gloves (6% using arthritis gloves; 7% using alternative gloves).

Overall, the trial shows that specialist arthritis gloves are no more effective than looser-fitting alternatives. Cheaper, non-specialist gloves had similar benefits.

Why is this important?

Arthritis gloves are commonly prescribed, but there is little evidence to support their use. This research found that they are no more effective at reducing symptoms than looser-fitting gloves. It showed that arthritis patients found the warmth most comforting about using gloves.

This means that cheaper alternatives would give the same benefits. This could save money for the NHS and for patients. Patients could decide to buy ordinary fingerless gloves for themselves. 

The research sheds light on the way gloves might work. They were thought to address hand pain and stiffness by exerting pressure. This study suggests that benefits to people with painful hands are more likely to be due to warmth and comfort.

Wearing gloves might also remind people to take care of their hands. It could encourage them to subtly change the way they use their hands. The researchers recommend that people with arthritis try for themselves wearing ordinary light-weight fingerless gloves.

What’s next?

Since special gloves are no more effective than loose-fitting alternatives, healthcare professionals should not prescribe them to patients. Future research should look at whether even cheaper gloves are effective for arthritis than the looser-fitting gloves used in this work. 

The researchers believe that similar results would be found in people with different types of hand arthritis. However, more research is needed to test this.

People in both groups reported some benefits from wearing gloves. They generally felt this was due to comfort and warmth but further work could explore how and why the gloves make a difference.  

You may be interested to read

This NIHR Alert is based on: Hammond A, and others. Clinical and cost effectiveness of arthritis gloves in rheumatoid arthritis (A-GLOVES): randomised controlled trial with economic analysis. BMC Musculoskeletal Disorders 2021;22:47 

Another summary of this research paper by Kudos - Arthritis gloves: are they effective and cost-effective? 

A summary of previous work highlighting the lack of evidence into arthritis gloves: Do arthritis gloves work? 

A video summary of this study: Prof Alison Hammond talks about the Arthritis Gloves Trial 

 

Funding: This paper presents independent research funded by the NIHR under its Research for Patient Benefit (RfPB) Programme.

Conflicts of Interest: The study authors declare no conflicts of interest.

Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Commentaries

Study author

Arthritis gloves have been prescribed since the 1980s. This research began about 7 years ago when our local rheumatology occupational therapists asked us about the evidence for prescribing arthritis gloves. We did a systematic review and only found about 10 articles. Only 4 were trials, all were old (1970s – 1990s) and most were very small (between 8 – 30 participants). The results could not conclude that the gloves were effective.

There is currently no guidance on when we should prescribe arthritis gloves. Occupational therapists give them to patients when they think they might help. We needed more evidence about these gloves. We worked with rheumatology occupational therapists and people with arthritis to design this trial to answer the question: do arthritis gloves work? We wanted to prevent patients from spending money on expensive arthritis gloves. 

Most patients liked the arthritis gloves and they helped a little. But importantly, the patients who had the loose-fitting gloves liked them just as much and found the same benefits. We have found that much cheaper alternatives can be just as beneficial.

Alison Hammond, Professor in Rheumatology Rehabilitation, University of Salford 

Versus Arthritis 

Rheumatoid arthritis (RA) is an autoimmune condition where the immune system attacks the joints, causing pain and stiffness. It affects about half a million people in the UK and can affect anyone over the age of 16, though children can be also affected by related types of arthritis.

Despite huge improvements in treatment, many people with RA still have difficulty using their hands, as well as pain and stiffness. It’s a shame that so-called ‘arthritis gloves’ are no better than placebo, but knowing this means health services and people with RA can save their money on these pricey products. 

NHS money would be better spent on other approaches, such as the SARAH 12-week tailored programme of hand exercises supported by therapists, which has been shown to help people with RA. Unfortunately, access to these programmes in the UK remains poor.

Benjamin Ellis, Consultant Rheumatologist and Senior Clinical Policy Adviser to Versus Arthritis 

Rheumatologist 

This research study showed that specific arthritis gloves are not associated with improvements in any of the clinical outcomes that are important to patients or clinicians. In my work as a rheumatologist, I would now not recommend these. It is important that this research is communicated to occupational therapists as they are key members of the healthcare team and often prescribe supports and aids, including gloves.

Laura Coates, Rheumatologist, University of Oxford and Oxford University Hospitals NHS Trust 

Lived experience

My daughter wears a glove currently but does not find it helpful. I tried a glove some time ago and it did not help me either, although this might have been because of an unsuitable fit. I am encouraged that this research may help professionals to look elsewhere to help people with painful hands.

Time and money should stop being wasted on these ineffective gloves. Resources could be used to do more work on things that might help sufferers. This research could save a lot of money.

Dianna Moylan, Public Contributor, Milton Keynes 

Member of the public

I have several friends and family members with chronic health conditions who could benefit from more work like this. We are always interested in research that could help with daily living and the management of long-term conditions.

Public Contributor (name supplied), Lancashire