Rheumatoid Arthritis Integrative Interventions

Publication Date: May 25, 2023

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
1. Fraenkel L, Bathon JM, England BR, St. Clair EW, Arayssi T, Carandang K, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res 2021;73:924-939.

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

Intervention...

...tions and examples of interventions inclu...


...xercise...

...hysical exerciseMovement of the body requirin...

...rformance of physical activity in regular and st...

...seExercise intended to improve cardiorespir...

Aquatic exerciseExercise performed in water, co...

...erciseExercise intended to increase musc...

...-body exerciseExercise that combines movement,...


Rehabilitation

...prehensive occupational therapyEvalu...

...nsive physical therapyEvaluation an...

Hand therapy exercisesExercises of the hand to im...


...ietary...

...rmally defined dietSpecific formally...

...rranean-style dietDiet pattern tha...

...mentSubstances used to add nutrients, b...

...lossIntentional loss of body weight. Exampl...


...dditional integrative th...

...programStandardized program to guide se...

...nitive behavioral therapyPsychological th...

...proachesPractices engaging both mi...

...unctureStimulation of specific body p...

...ubbing and kneading of muscles and joints with the...

...mal modalitiesUse of heat and cold...

...herapyUse of electrical energy for medic...

...timulationImplantation of a device...

...ticDiagnosis and manipulation of malalign...

...essationCounseling on tobacco cessation, to...


Recommendations for the Management of RAa

...mmendations for the Management of R...

...tervention definitions and examples are provided i...


A. Exercise recommendation...

...gly recommend consistent engagemen...

...y recommend consistent engagement in aerobic exerc...

...conditionally recommend consistent e...

...ally recommend consistent engagement in resistanc...

...ally recommend consistent engagement in...


B. Rehabilitation interventio...

...e conditionally recommend participation...

...conditionally recommend participati...

...patients with hand involvement, we conditionally...

...h hand and/or wrist involvement and/o...

...patients with foot and/or ankle involveme...

...ith foot and/or ankle involvement, we condition...

...h knee involvement, we conditionally...

...nally recommend use of joint protection t...

...ly recommend use of activity pacing...

...e conditionally recommend use of assistive devices...

...conditionally recommend use of ad...

...nditionally recommend use of environmental ad...

...patients who are currently employed or...

...ho are currently employed or desire to be...


...iet recommendation...

...ditionally recommend adherence to a Med...

...nditionally recommend against adherence t...

...onally recommend following established dietary rec...


...†Additional integrative interventi...

...ditionally recommend use of a standa...

...ally recommend use of cognitive behaviora...

...onditionally recommend use of acupuncture...

...tionally recommend use of massage...

...ditionally recommend use of thermal modalities o...

...recommend against using electrotherapy...

...nally recommend against using chiropractic therap...