ACR Releases Guideline Summary for Use of Exercise, Rehabilitation, and Diet in RA

The American College of Rheumatology (ACR) released a guideline summary on the use of exercise, diet, rehabilitation, and other integrative interventions, in addition to disease-modifying antirheumatic drug (DMARD) treatment, in the management of patients with rheumatoid arthritis (RA).

A guideline development group across multiple disciplines, including epidemiology, exercise physiology, occupational therapy, physical therapy, social work, integrative medicine, nursing, nutrition, and rheumatology, evaluated the literature for best evidence-based practices in the management of patients with RA. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to validate the accuracy of the literature.

Exercise

The panel strongly recommended that patients with RA should consistently engage in exercise and conditionally recommended various types of exercise, including aerobic exercise, aquatic exercise, resistance training, and mind-body exercise.

Rehabilitation

The panel conditionally recommended specific forms of rehabilitation, including comprehensive occupational and physical therapy; hand therapy; use of joint protection techniques; methods to preserve joint health, including splinting, taping, compression, orthotics, and bracing; use of assistive devices or adaptive equipment; and vocational-specific rehabilitation, work site evaluations, and/or workspace modifications.

Diet

A Mediterranean-style diet, which is high in fruits and vegetables, was recommended. The panel recommended against other formally defined diets or intake of dietary supplements for RA.

Additional Interventions

The panel conditionally recommended certain additional interventions, including acupuncture, massage therapy, thermal modalities, cognitive behavioral therapy, mind-body techniques, and standardized self-management programs.

However, they strongly recommended against the use of electrotherapy and chiropractic therapy for RA. “The broad range of interventions included in these recommendations illustrates the importance of an interprofessional team-based approach to RA management,” the authors said. “The conditional nature of most recommendations requires clinicians to engage patients in shared decision-making when applying these recommendations.”