2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis

Bryant R England¹, Benjamin J Smith², Nancy A Baker³, Jennifer L Barton⁴, Carol A Oatis⁵, Gordon Guyatt⁶, Allen Anandarajah⁷, Kristine Carandang⁸, Karmela Kim Chan⁹, Deb Constien¹⁰, Eileen Davidson¹¹, Carole V Dodge¹², Anita Bemis-Dougherty¹³, Sotiria Everett¹⁴, Nadine Fisher¹⁵, Liana Fraenkel¹⁶, Susan M Goodman⁹, Janet Lewis¹⁷, Victoria Menzies¹⁸, Larry W Moreland¹⁹, Iris Navarro-Millan²⁰, Sarah Patterson²¹, Lawrence Rick Phillips²², Neha Shah²³, Namrata Singh²⁴, Daniel White²⁵, Rawan AlHeresh²⁶, Kamil E Barbour²⁷, Thomas Bye²⁵, Dana Guglielmo²⁸, Rebecca Haberman²⁹, Tate Johnson¹, Anatole Kleiner⁷, Chris Y Lane³⁰, Linda C Li³¹, Hiral Master³², Daniel Pinto³³, Janet L Poole³⁴, Kimberly Steinbarger³⁵, Daniel Sztubinski³⁶, Louise Thoma³⁰, Vlad Tsaltskan³⁷, Marat Turgunbaev³⁸, Courtney Wells³⁹, Amy S Turner³⁸, Jonathan R Treadwell³⁶

Affiliations

¹ University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha.
² Florida State University, Tallahassee.
³ Tufts University, Boston, Massachusetts.
⁴ VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon.
⁵ Arcadia University, Glenside, Pennsylvania.
⁶ McMaster University, Hamilton, Ontario, Canada.
⁷ University of Rochester Medical Center, Rochester, New York.
⁸ San Diego, California.
⁹ Hospital for Special Surgery, New York.
¹⁰ Sun Prairie, Wisconsin.
¹¹ Burnaby, British Columbia, Canada.
¹² University of Michigan Hospital and Health System, Ann Arbor.
¹³ American Physical Therapy Association, Alexandria, Virginia.
¹⁴ Department of Family, Population, Preventive Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, New York.
¹⁵ University of Buffalo, Buffalo, New York.
¹⁶ Yale School of Medicine, New Haven, Connecticut.
¹⁷ University of Virginia, Charlottesville, Virginia.
¹⁸ University of Florida, Gainesville.
¹⁹ University of Colorado Anschutz Medical Campus, Aurora.
²⁰ Weill Cornell Medicine, New York.
²¹ UCSF Osher Center for Integrative Medicine, San Francisco, California.
²² Noblesville, Indiana.
²³ Stanford Health Care, Palo Alto, California.
²⁴ University of Washington, Seattle.
²⁵ University of Delaware, Newark.
²⁶ MGH Institute of Health Professions, Boston, Massachusetts.
²⁷ Centers for Disease Control and Prevention, Atlanta, Georgia.
²⁸ Research Consultant, Los Angeles, California.
²⁹ NYU Langone Health, New York.
³⁰ University of North Carolina at Chapel Hill.
³¹ University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, Canada.
³² Vanderbilt University Medical Center, VICTR, Nashville, Tennesee.
³³ Marquette University, Milwaukee, Wisconsin.
³⁴ University of New Mexico, Albuquerque.
³⁵ Husson University, Bangor, Maine.
³⁶ ECRI Institute, Plymouth Meeting, Pennsylvania.
³⁷ University of California, San Diego.
³⁸ American College of Rheumatology, Atlanta, Georgia.
³⁹ University of Wisconsin, River Falls.

PMID: 37227071
PMCID: PMC10947582
DOI: 10.1002/art.42507

2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis

Bryant R England et al. Arthritis Rheumatol. 2023 Aug.

. 2023 Aug;75(8):1299-1311.

doi: 10.1002/art.42507. Epub 2023 May 25.

Authors

Affiliations

¹ University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha.
² Florida State University, Tallahassee.
³ Tufts University, Boston, Massachusetts.
⁴ VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon.
⁵ Arcadia University, Glenside, Pennsylvania.
⁶ McMaster University, Hamilton, Ontario, Canada.
⁷ University of Rochester Medical Center, Rochester, New York.
⁸ San Diego, California.
⁹ Hospital for Special Surgery, New York.
¹⁰ Sun Prairie, Wisconsin.
¹¹ Burnaby, British Columbia, Canada.
¹² University of Michigan Hospital and Health System, Ann Arbor.
¹³ American Physical Therapy Association, Alexandria, Virginia.
¹⁴ Department of Family, Population, Preventive Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, New York.
¹⁵ University of Buffalo, Buffalo, New York.
¹⁶ Yale School of Medicine, New Haven, Connecticut.
¹⁷ University of Virginia, Charlottesville, Virginia.
¹⁸ University of Florida, Gainesville.
¹⁹ University of Colorado Anschutz Medical Campus, Aurora.
²⁰ Weill Cornell Medicine, New York.
²¹ UCSF Osher Center for Integrative Medicine, San Francisco, California.
²² Noblesville, Indiana.
²³ Stanford Health Care, Palo Alto, California.
²⁴ University of Washington, Seattle.
²⁵ University of Delaware, Newark.
²⁶ MGH Institute of Health Professions, Boston, Massachusetts.
²⁷ Centers for Disease Control and Prevention, Atlanta, Georgia.
²⁸ Research Consultant, Los Angeles, California.
²⁹ NYU Langone Health, New York.
³⁰ University of North Carolina at Chapel Hill.
³¹ University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, Canada.
³² Vanderbilt University Medical Center, VICTR, Nashville, Tennesee.
³³ Marquette University, Milwaukee, Wisconsin.
³⁴ University of New Mexico, Albuquerque.
³⁵ Husson University, Bangor, Maine.
³⁶ ECRI Institute, Plymouth Meeting, Pennsylvania.
³⁷ University of California, San Diego.
³⁸ American College of Rheumatology, Atlanta, Georgia.
³⁹ University of Wisconsin, River Falls.

PMID: 37227071
PMCID: PMC10947582
DOI: 10.1002/art.42507

Abstract

Objective: To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA).

Methods: An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.

Results: The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions.

Conclusion: This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team-based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision-making when applying these recommendations.

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Comment in

New guideline for integrative approaches to RA management.
McHugh J. McHugh J. Nat Rev Rheumatol. 2023 Aug;19(8):462. doi: 10.1038/s41584-023-00995-5. Nat Rev Rheumatol. 2023. PMID: 37400592 No abstract available.

References

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 & research. 2021;73(7):924–39. - PMC - PubMed
1. Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis and rheumatism. 2008;59(6):762–84. - PubMed
1. Singh JA, Furst DE, Bharat A, Curtis JR, Kavanaugh AF, Kremer JM, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis care & research. 2012;64(5):625–39. - PMC - PubMed
1. Singh JA, Saag KG, Bridges SL Jr., Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis & rheumatology (Hoboken, NJ). 2016;68(1):1–26. - PubMed
1. Andrews JC, Schünemann HJ, Oxman AD, Pottie K, Meerpohl JJ, Coello PA, et al. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. Journal of clinical epidemiology. 2013;66(7):726–35. - PubMed

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2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis

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2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis

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