# Therapeutic Electrical Stimulation Using Belt Electrodes and Nutritional Management in a Patient With Rheumatoid Arthritis and Sarcopenia: A Case Report

## TL;DR

A 73-year-old woman with rheumatoid arthritis and sarcopenia improved muscle mass and strength through a six-month program combining electrical stimulation and nutritional supplements.

## Contribution

This case report introduces a novel, safe rehabilitation strategy combining TES and nutrition for sarcopenia in RA patients.

## Key findings

- The patient showed increased muscle mass and strength after six months of treatment.
- No joint-related adverse events occurred during the TES and nutritional management.
- Physical performance improved, suggesting the treatment's efficacy and safety.

## Abstract

Patients with sarcopenia are recommended to undergo rehabilitation treatment consisting of resistance training and nutritional management. However, resistance training in patients with rheumatoid arthritis (RA) remains controversial because it may exacerbate joint impairments. Wide-area, low-pain therapeutic electrical stimulation (TES) using belt electrodes is a novel method that induces whole-muscle contractions in the lower limbs and has been increasingly adopted in clinical settings. This report describes a patient with concurrent RA and sarcopenia who underwent combined TES and nutritional management to assess its feasibility and efficacy. The patient was a 73-year-old woman who had been diagnosed with RA over one year ago, had initiated medication, and had low disease activity. As the patient had both RA and sarcopenia, a rehabilitation treatment combining novel TES and nutritional management was implemented over a six-month period. The patient underwent TES for 20 minutes once or twice a week as an outpatient. In addition, she was instructed to drink one nutritional supplemental drink containing the essential amino acid leucine daily at home. No joint-related adverse events occurred during the rehabilitation treatment, and the patient consumed the nutritional supplemental drink with high adherence. After six months, the patient’s muscle mass and strength had increased and physical performance had improved, suggesting that combined TES and nutritional management may be a feasible, safe, and effective strategy for treating sarcopenia in patients with RA. Many patients with RA only receive limited outpatient rehabilitation treatment. Our program combining TES and nutritional management as an alternative to resistance training may represent an important strategy to treat sarcopenia in patients with RA.