Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis
Publication Date: May 25, 2023
Last Updated: July 6, 2023
Recommendations for the Management of RAa
a Intervention definitions and examples are provided in the Interventions section.
A. Exercise recommendations
We strongly recommend consistent engagement in exercise over no exercise. (Moderate-quality evidence, Strong recommendation)
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We conditionally recommend consistent engagement in aerobic exercise over no exercise (Level of Evidence: Very low to low). (, Conditional recommendation)
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We conditionally recommend consistent engagement in aquatic exercise over no exercise. (Low-quality evidence, Conditional recommendation)
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We conditionally recommend consistent engagement in resistance exercise over no exercise. (Very low-quality evidence, Conditional recommendation)
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We conditionally recommend consistent engagement in mind-body exercise over no exercise. (Level of Evidence: Very low to low). (, Conditional recommendation)
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B. Rehabilitation interventions
We conditionally recommend participation in comprehensive occupational therapy over no comprehensive occupational therapy. (Very low-quality evidence, Conditional recommendation)
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We conditionally recommend participation in comprehensive physical therapy over no comprehensive physical therapy. (Very low-quality evidence, Conditional recommendation)
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For patients with hand involvement, we conditionally recommend performing hand therapy exercises over no hand therapy exercises. (Low-quality evidence, Conditional recommendation)
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For patients with hand and/or wrist involvement and/or deformity, we conditionally recommend use of splinting, orthoses, and/or compression over no splinting, orthoses, and/or compression. (Very low-quality evidence, Conditional recommendation)
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For patients with foot and/or ankle involvement, we conditionally recommend use of bracing, orthoses, and/or taping over no bracing, orthoses, and/or compression. (Very low-quality evidence, Conditional recommendation)
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For patients with foot and/or ankle involvement, we conditionally recommend use of bracing, orthoses, and/or taping over no bracing, orthoses, and/or compression. (Very low-quality evidence, Conditional recommendation)
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For patients with knee involvement, we conditionally recommend use of bracing and/or orthoses over no bracing and/or orthoses. (Level of Evidence: No studies met eligibility criteria). (, Conditional recommendation)
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We conditionally recommend use of joint protection techniques over no joint protection techniques. (Low-quality evidence, Conditional recommendation)
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We conditionally recommend use of activity pacing, energy conservation, activity modification, and/or fatigue management over no activity pacing, energy conservation, activity modification, and/or fatigue management. (Level of Evidence: No studies met eligibility criteria). (, Conditional recommendation)
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We conditionally recommend use of assistive devices over no assistive devices. (Level of Evidence: No studies met eligibility criteria). (, Conditional recommendation)
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We conditionally recommend use of adaptive equipment over no adaptive equipment. (Level of Evidence: No studies met eligibility criteria). (, Conditional recommendation)
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We conditionally recommend use of environmental adaptations over no environmental adaptations. (Level of Evidence: No studies met eligibility criteria). (, Conditional recommendation)
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For patients who are currently employed or desire to become employed, we conditionally recommend use of vocational rehabilitation over no work interventions. (Level of Evidence: No studies met eligibility criteria). (, Conditional recommendation)
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For patients who are currently employed or desire to become employed, we conditionally recommend work site evaluations and/or modifications over no work site evaluations and/or modifications. (Low-quality evidence, Conditional recommendation)
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C. Diet recommendations
We conditionally recommend adherence to a Mediterranean-style diet over no formally defined diet. (Level of Evidence: Low to moderate). (, Conditional recommendation)
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We conditionally recommend against adherence to a formally defined diet, other than Mediterranean-style. (Level of Evidence: Very low to moderate). (, Conditional recommendation)
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We conditionally recommend following established dietary recommendations without dietary supplements over adding dietary supplements. (Level of Evidence: Very low to moderate). (, Conditional recommendation)
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D. Additional integrative interventions
We conditionally recommend use of a standardized self-management program over no standardized self-management program. (Low-quality evidence, Conditional recommendation)
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We conditionally recommend use of cognitive behavioral therapy and/or mind-body approaches over no cognitive behavioral therapy and/or mind-body approaches. (Level of Evidence: Very low to low). (, Conditional recommendation)
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We conditionally recommend use of acupuncture over no acupuncture. (Low-quality evidence, Conditional recommendation)
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We conditionally recommend use of massage therapy over no massage therapy. (Very low-quality evidence, Conditional recommendation)
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We conditionally recommend use of thermal modalities over no thermal modalities. (Very low-quality evidence, Conditional recommendation)
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We conditionally recommend against using electrotherapy. (Low-quality evidence, Conditional recommendation)
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We conditionally recommend against using chiropractic therapy. (Level of Evidence: No studies met eligibility criteria). (, Conditional recommendation)
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Recommendation Grading
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Overview
Title
Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis
Authoring Organization
American College of Rheumatology
Publication Month/Year
May 25, 2023
Last Updated Month/Year
August 8, 2023
Supplemental Implementation Tools
Document Type
Guideline
Country of Publication
US
Target Patient Population
Adults with rheumatoid arthritis
Target Provider Population
Clinicians providing care to adults with rheumatoid arthritis
Inclusion Criteria
Adult, Older adult
Health Care Settings
Ambulatory, Correctional facility, Hospital, Long term care, Outpatient
Intended Users
Chiropractor, counselor, dietician nutritionist, nurse, nurse midwife, nurse practitioner, occupational therapist, physical therapist, physician, physician assistant, podiatrist, psychologist
Scope
Management
Diseases/Conditions (MeSH)
D001172 - Arthritis, Rheumatoid
Keywords
diet, exercise, weight loss, physical therapy, rehabilitation, rheumatoid arthritis, integrative medicine, acupuncture, Integrative Therapies, occupational therapy, hand therapy exercises, vocational rehabilitation, adaptive devices, cognitive behavioral therapy, massage therapy, electrotherapy, chiropractic, vagal nerve stimulation
Source Citation
England BR, Smith BJ, Baker NA, , et al. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis Rheumatol. 2023 May 25. doi: 10.1002/art.42507. Epub ahead of print. PMID: 37227071.
Supplemental Methodology Resources
Methodology
Number of Source Documents
32
Literature Search Start Date
November 6, 2021
Literature Search End Date
May 1, 2022