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L. Snetselaar, J. Jesus, Dana DeSilva, Eve Stoody (2021)
Dietary Guidelines for Americans, 2020–2025Nutrition Today, 56
Rheumatoid arthritis is a chronic, systemic in fl ammatory condition that requires early diagnosis, evaluation, and management to achieve optimal outcomes
Examine the delivery, education, and implementation of integrative interventions
Develop vocational rehabilitation programs and work site modi fi cations that improve the ability of individuals with rheumatoid arthritis to work without negative stigma in the workplace
Devices to correct and support musculoskeletal function, improve joint alignment, or protect the joint. Examples include wrist and fi nger splints,
Training programs to overcome barriers preventing successful employment
Andrew Vreede, H. Johnson, Megan Piper, D. Panyard, Joanna Wong, C. Bartels (2017)
Rheumatologists Modestly More Likely to Counsel Smokers in Visits Without Rheumatoid Arthritis Control: An Observational StudyJCR: Journal of Clinical Rheumatology, 23
Devices to assist with activities of daily living. Examples include built-up and/or long-handled equipment, sock aide, button hook, reachers, pill cutters, cell phone holders
O. Vittecoq, L. Richard, C. Banse, T. Lequerré (2017)
The impact of smoking on rheumatoid arthritis outcomes.Joint, bone, spine : revue du rhumatisme, 85 2
K. Saag, Catherine Finney, Jeffrey Curtis, H. Paulus, Mary Elkins-Melton, R. Outman, J. Allison, S. Bridges, Jr, W. Chatham, D. Furst
American College of Rheumatology 2008 Recommendations for the Use of Nonbiologic and Biologic Disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis
Exercises of the hand to improve mobility and strength
K. Rees, A. Takeda, Nicole Martin, Leila Ellis, Dilini Wijesekara, A. Vepa, Archik Das, L. Hartley, S. Stranges (2019)
Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease.The Cochrane database of systematic reviews, 3
Daphna Katz-Talmor, I. Katz, B. Porat-Katz, Y. Shoenfeld (2018)
Cannabinoids for the treatment of rheumatic diseases — where do we stand?Nature Reviews Rheumatology, 14
Evidence-based research about cannabis
Lenore Buckley, G. Guyatt, Howard Fink, Michael Cannon, Jennifer Grossman, Karen Hansen, M. Humphrey, Nancy Lane, M. Magrey, Marc Miller, Lake Morrison, Madhumathi Rao, Angela Robinson, Sumona Saha, Susan Wolver, R. Bannuru, E. Vaysbrot, M. Osani, Marat Turgunbaev, Amy Miller, T. McAlindon (2017)
American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis
Explore Measures & Activities
Establish the cost-effectiveness of different integrative interventions and develop approaches for cost-effective delivery
Establish dedicated funding from organizations to study integrative rheumatoid arthritis therapies and their implementation
the assembly of, communication between, and role delineation among the interprofessional care team delivering pharmacologic and integrative interventions
Rheumatoid arthritis should be treated with disease-modifying antirheumatic drugs and follow a treat-to-target management strategy
Jasvinder Singh, K. Saag, S. Bridges, E. Akl, R. Bannuru, M. Sullivan, E. Vaysbrot, Christine McNaughton, M. Osani, R. Shmerling, Jeffrey Curtis, Daniel Furst, D. Parks, Arthur Kavanaugh, James O'dell, Charles King, Amye Leong, E. Matteson, J. Schousboe, B. Drevlow, Seth Ginsberg, J. Grober, E. Clair, Elizabeth Tindall, Amy Miller, Kelly Clayton, R. Crow‐Hercher, Shantana Hazel, Brittney Johnson, Leslie Rott, Whitney White, C. Wiedmeyer, V. Montori, W. Nowell, Kaleb Michaud, L. Davis, Brian Sauer, E. Solow, A. Reimold, Pascale Schwab, Joshua Baker (2015)
American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis
Individuals with chronic diseases like rheumatoid arthritis seek many available therapies to maintain physical function, reduce pain, and improve their quality of life
J. Singh, K. Saag, S. Bridges, E. Akl, R. Bannuru, M. Sullivan, E. Vaysbrot, Christine McNaughton, M. Osani, R. Shmerling, J. Curtis, D. Furst, D. Parks, A. Kavanaugh, J. O'dell, Charles King, Amye Leong, E. Matteson, J. Schousboe, B. Drevlow, S. Ginsberg, J. Grober, E. St.clair, E. Tindall, Amy Miller, T. McAlindon (2016)
2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid ArthritisArthritis Care & Research, 68
P. Hsieh, O. Wu, C. Geue, E. McIntosh, I. McInnes, S. Siebert (2020)
Economic burden of rheumatoid arthritis: a systematic review of literature in biologic eraAnnals of the Rheumatic Diseases, 79
J. Gillick, J. Wainwright, K. Das (2015)
Rheumatoid Arthritis and the Cervical Spine: A Review on the Role of SurgeryInternational Journal of Rheumatology, 2015
L. Ge, B. Sadeghirad, G. Ball, B. Costa, C. Hitchcock, A. Svendrovski, Ruhi Kiflen, Kalimullah Quadri, Henry Kwon, M. Karamouzian, T. Adams-Webber, Waleed Ahmed, Samah Damanhoury, D. Zeraatkar, A. Nikolakopoulou, R. Tsuyuki, Jinhui Tian, Kehu Yang, G. Guyatt, B. Johnston (2020)
Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trialsThe BMJ, 369
Evaluation and treatment by an occupational therapist with the goal of increasing physical function and participation. Receives patient-centered individualized treatment
C. Bartels, L. Johnson, E. Ramly, D. Panyard, A. Gilmore-Bykovskyi, H. Johnson, P. Mcbride, Zhanhai Li, E. Sampene, D. Lauver, K. Lewicki, Megan Piper (2021)
Impact of a Rheumatology Clinic Protocol on Tobacco Cessation Quit Line ReferralsArthritis Care & Research, 74
K. Powell, A. King, D. Buchner, W. Campbell, L. DiPietro, K. Erickson, C. Hillman, J. Jakicic, K. Janz, P. Katzmarzyk, W. Kraus, R. Macko, D. Marquez, A. McTiernan, R. Pate, L. Pescatello, M. Whitt-Glover (2019)
The Scientific Foundation for the Physical Activity Guidelines for Americans, 2nd Edition.Journal of physical activity & health
Balancing activity and rest to accomplish activities. Includes activity pacing, energy conservation, activity modi fi cation, fatigue management techniques
A. Lichtenstein, L. Appel, M. Vadiveloo, F. Hu, P. Kris-Etherton, C. Rebholz, F. Sacks, A. Thorndike, L. Horn, J. Wylie-Rosett (2021)
2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart AssociationCirculation, 144
Recommendations pertain to rheumatoid arthritis management. Recommendations do not pertain to clinical situations in which patients have alternative indications for listed treatments
K. Wipfler, T. Simon, P. Katz, F. Wolfe, K. Michaud (2021)
Increase in Cannabis Use Among Adults With Rheumatic Diseases: Results From a 2014–2019 United States Observational StudyArthritis Care & Research, 74
M. Jensen, D. Ryan, C. Apovian, J. Ard, Anthony Comuzzie, K. Donato, F. Hu, V. Hubbard, J. Jakicic, R. Kushner, C. Loria, B. Millen, C. Nonas, F. Pi‐Sunyer, J. Stevens, V. Stevens, T. Wadden, B. Wolfe, S. Yanovski, H. Jordan, Karima Kendall, L. Lux, R. Mentor-Marcel, Laura Morgan, M. Trisolini, J. Wnek, Jeffrey Anderson, J. Halperin, N. Albert, B. Bozkurt, R. Brindis, L. Curtis, D. DeMets, J. Hochman, R. Kovacs, E. Ohman, S. Pressler, F. Sellke, W. Shen, Sidney Smith, G. Tomaselli (2013)
2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in AdultsCirculation, 129
G. Guyatt, A. Oxman, G. Vist, R. Kunz, Y. Falck-Ytter, P. Alonso-Coello, H. Schünemann (2008)
GRADE: an emerging consensus on rating quality of evidence and strength of recommendationsBMJ : British Medical Journal, 336
Determine the appropriate timing of different integrative interventions in the rheumatoid arthritis disease course
Evaluate dietary supplements (especially vitamin D and omega-3 fatty acids such as “ fi sh oil ” ) in the context of dietary intake
(2018)
Physical Activity Guidelines for Americans
S. Curry, A. Krist, D. Owens, M. Barry, A. Caughey, K. Davidson, Chyke Doubeni, J. Epling, D. Grossman, A. Kemper, Martha Kubik, C. Landefeld, C. Mangione, M. Phipps, Michael Silverstein, M. Simon, Chien-Wen Tseng, J. Wong (2018)
Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: US Preventive Services Task Force Recommendation StatementJAMA, 320
T. Sokka, A. Häkkinen, H. Kautiainen, J. Maillefert, S. Toloza, Troels Hansen, J. Calvo-Alén, R. Oding, Margareth Liveborn, M. Huisman, R. Alten, C. Pohl, M. Cutolo, K. Immonen, A. Woolf, Eithne Murphy, C. Sheehy, Edel Quirke, S. Çelik, Y. Yazici, W. Tłustochowicz, D. Kapołka, V. Skakić, B. Rojkovich, Raili Müller, S. Stropuvienė, D. Andersone, A. Drosos, J. Lazovskis, T. Pincus (2008)
Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study.Arthritis and rheumatism, 59 1
Tailor interventions (and their delivery) studied in the general population to individuals with rheumatoid arthritis, e.g., tobacco cessation programs, exercise programs, and weight loss
diets include antiin fl ammatory, Mediterranean-style, ketogenic, paleo, gluten-free, vegetarian, vegan, intermittent fasting, elemental, elimination, raw foods, whole food plant-based
B. England, Benedict Tiong, M. Bergman, J. Curtis, S. Kazi, T. Mikuls, J. O'dell, V. Ranganath, A. Limanni, L. Suter, K. Michaud (2019)
2019 Update of the American College of Rheumatology Recommended Rheumatoid Arthritis Disease Activity MeasuresArthritis Care & Research, 71
US Department of Agriculture and US Department of Health and Human Services. Dietary Guidelines for Americans
Devices to assist with mobility. Examples include crutches, canes, walkers
modifying exercise interventions based on disease activity level or diet based on disease-modifying antirheumatic drugs utilized
A. Hresko, Tzu-Chieh Lin, D. Solomon (2018)
Medical Care Costs Associated With Rheumatoid Arthritis in the US: A Systematic Literature Review and Meta‐AnalysisArthritis Care & Research, 70
J. Singh, D. Furst, A. Bharat, J. Curtis, A. Kavanaugh, J. Kremer, L. Moreland, J. O'dell, K. Winthrop, T. Beukelman, S. Bridges, W. Chatham, H. Paulus, M. Suarez‐Almazor, C. Bombardier, M. Dougados, D. Khanna, Charles King, Amye Leong, E. Matteson, J. Schousboe, Eileen Moynihan, K. Kolba, Archana Jain, E. Volkmann, Harsh Agrawal, S. Bae, A. Mudano, N. Patkar, K. Saag (2012)
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 arthritisArthritis Care & Research, 64
Improve access to experienced healthcare professionals who provide integrative interventions
Establish the ef fi cacy and safety of integrative therapies on extraarticular manifestations and long-term rheumatoid arthritis – related outcomes
D. Poudel, M. George, J. Baker (2020)
The Impact of Obesity on Disease Activity and Treatment Response in Rheumatoid ArthritisCurrent Rheumatology Reports, 22
Treatment decisions should follow a shared decision-making process. Individuals with rheumatoid arthritis present with a variety of manifestations and experiences
E. Philippou, E. Nikiphorou (2018)
Are we really what we eat? Nutrition and its role in the onset of rheumatoid arthritis.Autoimmunity reviews, 17 11
MD Jensen, DH Ryan, CM Apovian (2014)
2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society, 129
Identify barriers to the adoption and implementation of integrative therapies. These may include variability in access, costs, and implicit and/or explicit biases
ef fi cacy and safety of therapies not included in this guideline such as cannabidiol, vaping, and occupational exposures and protections as well as emerging therapies such as vagal nerve stimulation
T. Lancaster, L. Stead (2004)
Physician advice for smoking cessation.The Cochrane database of systematic reviews, 4
Evaluation and treatment by a physical therapist
Recommendations assume no contraindications to listed management strategies
Evaluating and adjusting work site conditions and duties for safety and well-being
We conditionally recommend use of assistive devices over no assistive devices
M. Brouwers, M. Kho, G. Browman, J. Burgers, F. Cluzeau, G. Feder, B. Fervers, I. Graham, J. Grimshaw, S. Hanna, P. Littlejohns, J. Makarski, L. Zitzelsberger (2010)
AGREE II: advancing guideline development, reporting and evaluation in health careCanadian Medical Association Journal, 182
J. Andrews, H. Schünemann, A. Oxman, K. Pottie, J. Meerpohl, P. Coello, D. Rind, V. Montori, J. Brito, S. Norris, M. Elbarbary, Piet Post, M. Nasser, Vijay Shukla, Roman Jaeschke, J. Brożek, B. Djulbegovic, G. Guyatt (2013)
GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation's direction and strength.Journal of clinical epidemiology, 66 7
For patients with knee involvement, we conditionally recommend use of bracing and/or orthoses over no bracing and/or orthoses
James Green, C. Hohmann, Kelsi Lister, Riani Albertyn, Renee Bradshaw, Christine Johnson (2016)
Implicit and explicit attitudes towards conventional and complementary and alternative medicine treatments: Introduction of an Implicit Association TestJournal of Health Psychology, 21
Optimum rheumatoid arthritis treatment outcomes are achieved through interprofessional teams providing expert patient-centered care
L. Fraenkel, J. Bathon, B. England, E. St.clair, T. Arayssi, Kristine Carandang, K. Deane, M. Genovese, K. Huston, G. Kerr, J. Kremer, Mary Nakamura, L. Russell, Jasvinder Singh, Benjamin Smith, J. Sparks, S. Venkatachalam, M. Weinblatt, Mounir Al-Gibbawi, J. Baker, K. Barbour, J. Barton, L. Cappelli, Fatimah Chamseddine, M. George, S. Johnson, Lara Kahale, Basil Karam, A. Khamis, I. Navarro-Millán, R. Mirza, P. Schwab, Namrata Singh, Marat Turgunbaev, Amy Turner, Sally Yaacoub, E. Akl (2021)
2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid ArthritisArthritis Care & Research, 73
Determine ef fi cacy and safety of integrative interventions based on rheumatoid arthritis disease manifestations and pharmacologic therapies
Gabriela Spencer‐Bonilla, Ana Quiñones, V. Montori, O. Workgroup (2017)
Assessing the Burden of TreatmentJournal of General Internal Medicine, 32
Disease activity and disease activity levels refer to those calculated using an ACR-endorsed rheumatoid arthritis
Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) are intended to provide guidance for patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to the recommendations within this guideline to be voluntary, with the ultimate determination regarding their application to be made by the clinician in light of each patient's individual circumstances. Guidelines and recommendations are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome. Guidelines and recommendations developed and endorsed by the ACR are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice. ACR recommendations are not intended to dictate payment or insurance decisions, and drug formularies or other third‐party analyses that cite ACR guidelines should state this. These recommendations cannot adequately convey all uncertainties and nuances of patient care.The American College of Rheumatology is an independent, professional medical, and scientific society that does not guarantee, warrant, or endorse any commercial product or service.INTRODUCTIONRheumatoid arthritis (RA) is a chronic, systemic inflammatory condition, and improved outcomes occur with early diagnosis, evaluation, and management. The American College of Rheumatology (ACR) has previously published pharmacologic guidelines to aid
Arthritis & Rheumatology – Wiley
Published: Aug 1, 2023
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