Rheumatoid Arthritis Integrative Interventions
Key Points
Key Points
Integrative Interventions for Rheumatoid Arthritis Guiding Principles:
- Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory condition that requires early diagnosis, evaluation, and management to achieve optimal outcomes.
- Rheumatoid arthritis should be treated with disease-modifying anti-rheumatic drugs and follow a treat-to-target management strategy, as detailed in the 2021 American College of Rheumatology (ACR) Rheumatoid Arthritis Pharmacologic Treatment Guidelines.1
- Persons with chronic diseases, like rheumatoid arthritis, seek many available therapies to maintain physical function, reduce pain, and improve their quality of life.
- Treatment decisions should follow a shared decision-making process. Persons with rheumatoid arthritis present with a variety of manifestations and experiences.
- Optimum rheumatoid arthritis treatment outcomes are achieved through interprofessional teams providing expert patient-centered care.
- Recommendations assume no contraindications to listed management strategies.
- Recommendations pertain to rheumatoid arthritis management.
- Recommendations do not pertain to clinical situations when patients have alternative indications for listed treatments.
- Other general health benefits may exist for listed treatments.
- Surgical interventions are not included in this guideline because there are other guideline efforts that address large joint replacement, and small joint surgeries are not frequently a part of the current management of rheumatoid arthritis.
- Disease activity and disease activity levels refer to those calculated using an ACR-endorsed RA disease activity measure.2
2. England BR, Tiong BK, Bergman MJ, Curtis JR, Kazi S, Mikuls TR, et al. 2019 Update of the American College of Rheumatology Recommended Rheumatoid Arthritis Disease Activity Measures. Arthritis Care. 2019;71:1540-1555.
Interventions
Interventio...
Descriptions and examples of interventions...
Exerci...
Physical exerciseMovement of the body requiring en...
...sePerformance of physical activity in reg...
...robic exerciseExercise intended to improve cardio...
...eExercise performed in water, containing element...
...ce exerciseExercise intended to increase mu...
...dy exerciseExercise that combines movement, mental...
Rehabilitat...
...ccupational therapyEvaluation and treatment by o...
...sive physical therapyEvaluation and treatment b...
...and therapy exercisesExercises of the hand to i...
...ietary...
...ined dietSpecific formally defined diets...
...erranean-style dietDiet pattern that empha...
...tary supplementSubstances used to add nu...
...ntentional loss of body weight. Examples in...
Additional integrative therap...
...gement programStandardized program to guide se...
...e behavioral therapyPsychological therapy to id...
...ind-body approachesPractices engaging...
...ulation of specific body points through inse...
...ubbing and kneading of muscles and joints...
...litiesUse of heat and cold for med...
...rotherapyUse of electrical energy for me...
...al nerve stimulationImplantation of a dev...
...iropracticDiagnosis and manipulation of malali...
...onCounseling on tobacco cessation, tobacco cessat...
Recommendations for the Management of RAa
...ions for the Management of RAa...
...efinitions and examples are provided i...
...xercise recommendation...
...trongly recommend consistent engageme...
...e conditionally recommend consistent e...
...ly recommend consistent engagement i...
We conditionally recommend consistent engag...
...onally recommend consistent engagement in mind-...
B. Rehabilitation interven...
...onditionally recommend participation in c...
...tionally recommend participation in comprehensive...
...atients with hand involvement, we con...
...ients with hand and/or wrist involvement...
...s with foot and/or ankle involvement, we condition...
...ients with foot and/or ankle involvement, we c...
...ts with knee involvement, we conditionally reco...
...tionally recommend use of joint protection techni...
...onditionally recommend use of activ...
...y recommend use of assistive devices ov...
...ally recommend use of adaptive equipmen...
...conditionally recommend use of environm...
...ents who are currently employed or d...
...nts who are currently employed or desire to become...
C. Diet recommendatio...
...lly recommend adherence to a Mediterranean-sty...
...y recommend against adherence to a formally defi...
...nally recommend following established dietary re...
...Additional integrative inter...
...e conditionally recommend use of a standardized se...
...nally recommend use of cognitive behav...
...onditionally recommend use of acupuncture over no...
...onditionally recommend use of massage therapy...
...recommend use of thermal modalities o...
...onally recommend against using electrotherapy. (Lo...
...onally recommend against using chiropractic ther...