What else can I do but take drugs? The future of research in nonpharmacological treatment in early inflammatory arthritis.

Nonpharmacological treatments, including physiotherapy and occupational therapy, have assumed a complementary role to drug therapy in managing inflammatory arthritis. Clinicians and researchers are facing 3 major challenges concerning the use of these treatments. First, strong evidence is only present in a few nonpharmacological interventions, such as exercise, patient education, and low level laser in the treatment of rheumatoid arthritis. The evidence on the majority of interventions is, however, weak or inconclusive. Second, knowledge is lacking on the elements associated with models of nonpharmacological care. The multidisciplinary team approach has been viewed as the standard for arthritis treatment; however, the team structure and the communication style among team members vary around the world. The influence of these elements on treatment success remains unclear. Finally, disparities in knowledge management and translation in nonpharmacological research have hindered the clinical use of these treatments and the growth of research in the field. To address the challenges, the author is recommending 4 research priorities for nonpharmacological treatments: 1. Evaluation of less well-studied interventions; 2. Understanding the relationships among rehabilitation-related variables and disability; 3. Development and evaluation of innovative care models; and 4. Design and evaluation of knowledge transfer innovations.