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Juvenile Rheumatoid Arthritis

This study measured the effects of massage therapy on children and adolescents with Juvenile Rheumatoid
Arthritis (JRA). Those receiving the massage were expected to report lower levels of anxiety, depression,
and pain and to have lower cortisol levels.

September 16, 2009  By Massage Therapy Magazine

This study measured the effects of massage therapy on children and adolescents with Juvenile Rheumatoid
Arthritis (JRA). Those receiving the massage were expected to report lower levels of anxiety, depression,
and pain and to have lower cortisol levels. Teaching the parents to massage their children was
expected to give the parents a positive role in their child’s treatment and thereby reduce their own anxiety levels.



Juvenile Rheumatoid Arthritis is the most common rheumatic disease of childhood and one of the most common chronic diseases of childhood (Cassidy & Petty, 1995; Lovell & Walco, 1989).

The JRA diagnosis is based on the observation of persistent arthritis (6 or more weeks duration) in one or more joints. The disease typically manifests itself before 16 years of age, with peak onset in the age groups 1 to 3 and 8 to 12 years (Varni & Jay, 1984). Common symptoms include night pain and joint stiffness both during the morning and following long periods of inactivity.

The overall management of JRA consists of a multi-disciplinary approach to comprehensive care. Despite the comprehensive approach to patient care, pain remains an undertreated clinical problem (Lovell & Walco, 1989)


Because of the limited effects of anti-inflammatory drugs and the reluctance to use narcotics for pain reduction, investigators have been exploring other methods including meditation, progressive muscle relaxation, and guided imagery (Walco, Varni, & Ilowite, 1992).

The sample comprised 20 children (14 girls, 6 boys) age 5.4 – 14.8 years (M = 9.8) who had been diagnosed with JRA on average 4.4 years previously and who were recruited from two rheumatologists. On average the rheumatologists scored these children 7.4 on the Juvenile Arthritis Functional Assessment.

The children were assigned randomly to massage therapy or relaxation therapy groups. The parents in each group were given demonstrations and videotapes demonstrating the therapy techniques. During the study the children continued to receive standard medical care including examinations by a pediatric rheumatologist.

Massage Therapy

These children received a daily 15-minute massage at bedtime by one of their parents for 30 days. The parent most involved with the child’s medical regime was trained to administer the massage by a massage therapist. 

Relaxation Therapy
These children experienced a 15-minute relaxation session at bedtime with their parents every night for 30 days. These sessions were performed with the subjects laying on their back and being instructed to tighten and relax different muscles of the body. The following large muscle groups were involved (a) face, (b) back, (c) arms, (d) hands, (e) thighs (f) calves, and (g) feet.



A pediatric rheumatologist assessed the child’s pain and the parents completed questionnaires on their perception of their child’s pain. Pain was also assessed by the child. A behaviour observation of the child’s anxiety level was made and the child’s saliva was assayed for stress hormone (cortisol) levels. These assessments were made before and after the sessions on the first and last day of the 30-day study. 

Pre-Post Session Assessments
for Massage and Relaxation Groups Post hoc analyses revealed the following immediate effects favoring the massage group including (a) lower parent anxiety by self-report on the State Anxiety Inventory; (b) lower child anxiety based on behavioural observation; and (c) lower stress hormone levels (salivary cortisol) in the children receiving the massage.

The immediate effects of the massage therapy including the reduced anxiety levels in the parents administering the massage, lower child anxiety based on the children are perhaps not surprising because other studies on massage therapy with children have reported similar effects.

Summary of Results

This study suggests that parents massaging their children with JRA before bedtime each day can help decrease their anxiety and stress hormone levels. After 30 days of massage therapy, the children were also experiencing less pain, thus confirming the pain-relieving effects of massage therapy.  Although the underlying mechanism for the massage therapy pain reduction relationship is not known, massage seems to be a cost-effective therapy for children with Juvenile Rheumatoid Arthritis. The parents reported that they enjoyed massaging their children and felt that they were “contributing to their treatment.”

• Tiffany Field, 2 Maria Hernandez-Reif, Susan Seligman, Josh Krasnegor, and William Sunshine, University
of Miami School of Medicine
• Rafael Rivas-Chacon, Miami Children’s Hospital
• Saul Schanberg and Cynthia Kuhn, Duke University Medical School

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