ACR publishes new guideline offering recommendations for an integrative approach to RA treatment

ACR publishes new guideline offering recommendations for an integrative approach to RA treatment

The American College of Rheumatology (ACR) has published a summary of its new guidelines for exercise, rehabilitation, nutrition, and additional integrative interventions for rheumatoid arthritis. This is the first ACR guideline on an integrative approach to rheumatoid arthritis (RA) and is intended to complement the 2021 ACR guideline on the treatment of RA, which covers pharmacological therapies.

Along with pharmacological treatment options, exercise, rehabilitation, nutrition, and additional integrative interventions are considered as possible adjunctive treatments for RA. Patients and clinicians often seek evidence-based insights into these treatment options. Recognizing the need to assist patients and clinicians in considering treatments to complement their pharmacologic regimen, the ACR has developed this guideline.”

Benjamin J. Smith, DMSc, PA-C, DFAAPA, interim program director and associate dean at Florida State University College of Medicine and co-principal investigator of the guideline

The guideline contains 28 recommendations; only one recommendation was strong. Of the 27 conditional recommendations, four related to exercise, 13 to rehabilitation, three to nutrition, and seven to additional integrative interventions.

The one strong recommendation is that consistent engagement in exercise is recommended over no exercise. The type of exercise, frequency, intensity and duration is not formally defined, but the guideline emphasizes “regular exercise.” The specific elements of an exercise intervention should be tailored to each patient at the given point in their disease progression, taking into account their abilities, access and other health conditions.

It is important that guideline recommendations address RA-specific outcomes. For example, the guideline recommends following a Mediterranean diet over no formally defined diet. The Mediterranean diet emphasizes the intake of vegetables, fruits, whole grains, nuts, seeds, and olive oil; moderate amounts of low-fat milk and fish; and limit added sugars, sodium, highly processed foods, refined carbohydrates and saturated fats.

"The conditional recommendation to adhere to a Mediterranean diet, but not other formally defined diets, to improve RA-specific outcomes may be surprising to some clinicians," said Bryant R. England, MD, PhD, associate professor of rheumatology and immunology at the University of Nebraska Medical Center and one of the guideline's co-principal investigators. “However, the voting panel recognized that other health indications for alternative nutrition and supplements may exist, making it critical for physicians and patients to engage in shared decision-making.”

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The patient panel that contributed to the guideline recommendations emphasized that rheumatologists are often the first point of contact for treatment decisions. It is important for patients that their clinicians are knowledgeable about integrative therapies and help refer patients to other members of the interprofessional care team with appropriate expertise (e.g., occupational therapists, physical therapists, nutritionists, etc.).

"The ability to incorporate the multiple integrative interventions in the management of individuals with RA throughout their disease course as an interdisciplinary team is critical. This guideline highlights the important role that expert members of interprofessional healthcare teams play in providing optimal care for people with RA," said Dr. Smith.

Dr. Smith will co-moderate the discussion of the recommendations during a session at ACR Convergence 2022 on Sunday, November 13, 2022, at 4:30 p.m. ET in Exhibit Hall A of the Pennsylvania Convention Center. The session will also be streamed live via the ACR Convergence 2022 online meeting platform. The learning objectives for this session include:

• Fassen Sie den Entwurf der ACR-Empfehlungen für Bewegung, Rehabilitation, Ernährung und zusätzliche integrative Interventionen für RA zusammen
• Bewerten Sie den Evidenzgrad, der Empfehlungen für integrative Therapien bei RA unterstützt
• Demonstrieren Sie einen gemeinsamen Entscheidungsfindungsansatz zur Diskussion integrativer Therapien für RA

Free press registration is available to journalists who wish to view the policy session and other content presented at ACR Convergence 2022. Eligibility guidelines and registration details are available at https://www.rheumatology.org/Annual-Meeting/Press.

A full manuscript has been submitted for journal review and is expected to be published in rheumatology journals in spring 2023. The summary of guideline recommendations can be viewed in full on the ACR website.

Source:

American College of Rheumatology

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