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ACR's first guide to integrated management interventions for RA!
The annual American College of Rheumatology (ACR) is one of the world's largest and most influential international conferences, bringing together world-class basic science and clinical researchers, clinicians, and nursing research groups
.
The 2022 ACR Conference was successfully concluded on November 10-14 in Philadelphia, Pennsylvania
, USA.
In this session, ACR has developed new clinical practice guidelines for diet, exercise, rehabilitation, and other complementary interventions for patients with rheumatoid arthritis (RA), with final publication expected in spring
2023.
During the development of the guidelines, an interdisciplinary group was established to develop questions
based on PICO principles (study population, intervention, comparison, and outcome/outcome).
The certainty of the evidence was rated
through a systematic literature review and the application of the Assessment, Development and Evaluation of Recommendations (GRADE) approach.
The guideline development process made it clear that the integrative interventions considered in this guideline should complement pharmacotherapy, emphasize a multidisciplinary approach to the management of RA, and emphasize the need for shared decision-making
when caring for patients with RA.
The guidelines provide an initial recommendation for ACR's comprehensive interventions for the management of RA to complement the treatment
of DMARDs.
The wide range of interventions included in these recommendations illustrates the importance
of a team-based, interprofessional approach to RA management.
In this guide, the following principles are established:
RA should be treated with DMARDs, as detailed in pharmacotherapy guidelines
.Suitable for RA-specific management and outcomes rather than other medical indications or general health benefits
.It is assumed that there are no contraindications
.The best treatment outcomes are achieved through patient-centered, specialized care provided by interprofessional teams
.Treatment decisions should follow a common decision-making process
.
recommendation.
Exercise
This guide strongly recommends sticking to exercise, not not not exercising at all
.
Continuous participation in one or more exercises, including aerobic exercise, water exercise, resistance exercise, and mind-body exercise (e.
g.
, yoga, tai chi, qigong),
is recommended.
rehabilitation
Comprehensive occupational therapy and physiotherapy
are recommended if available.
The following are conditionally recommended:
Hand therapy exercises
Splints, orthoses, pressurizations, braces, and/or straps
Joint protection techniques
Auxiliary equipment
Adaptive equipment
Environmental adaptation
Vocational rehabilitation
Workplace assessment and/or adjustments
diet
In terms of diet, guidelines conditionally recommend adherence to a Mediterranean-style diet, opposition to a formally defined diet other than the Mediterranean diet, following established dietary recommendations, and not using dietary supplements
.
Other integrated interventions
Standardized self-management programs, cognitive behavioral therapy and/or psychosomatic approaches, acupuncture, massage therapy, and hyperthermia are recommended if available
.
Electrotherapy and chiropractic
are not recommended.
Patients with RA should be encouraged to quit smoking and maintain a healthy weight
.
Existing measures of smoking cessation quality were used to assess the effectiveness
of patients to quit smoking.
For obese or overweight patients, there are many different weight loss interventions (medications, surgical treatments, etc.
) to choose from
.
All clinicians can be involved in counseling and helping patients find the right intervention for them
.
In the intervention of early RA, it is important to educate patients about the different
interventions in different RA manifestations, severity, and course of the disease.
Given each person's abilities and difficulties, clinicians should provide patients with help
on how to access interventions.
Comprehensive interventions for RA need to be tailored to the specific situation of the patient and should not be uniform
.
In addition, the building of interprofessional teams is essential
for the management of RAs.
Late in the course of RA, clinicians and patients should work together to understand current capabilities and challenges, jointly determine the path to management, and understand comprehensive interventions
that may reduce challenges and improve capacity.
Clinicians should focus on questioning and listening
to patients.
Patients with multiple complications should be managed in collaboration with other clinicians
.
Where to see more rheumatology clinical knowledge? Come to the "doctor's station" and take a look 👇
