Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis

Publication Date: May 25, 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

Publication Month/Year

May 25, 2023

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

Evidence Tables

Methodology

Number of Source Documents
32
Literature Search Start Date
November 6, 2021
Literature Search End Date
May 1, 2022