OBJECTIVE: To develop clinical practice guidelines for the use of nonpharmacological treatments in patients with early rheumatoid arthritis (RA), using the evidence-based approach and expert opinion. METHODS: A scientific committee used a Delphi prioritization procedure to select five questions. Evidence providing answers to the five questions was sought in the literature and presented to a panel of rheumatologists. The panel developed five detailed recommendations, filling gaps in evidence with their expert opinion. The strength of each recommendation was determined. RESULTS: Of the 565 publications retrieved by the literature review, 198 were included in the analysis. The five recommendations on nonpharmacological treatments for early RA were validated by a final vote among all participants. The recommendations are as follows: (1) physicians may decide to provide joint protection education to patients with potentially severe early RA, with the knowledge that structured joint protection programs have not been found effective; (2) physical exercise and sports can be recommended to patients with early RA; muscle strength exercises are advisable; (3) in patients with early RA, metatarsal pain and/or foot alignment abnormalities should be looked for regularly, and appropriate insoles should be prescribed if needed; (4) dietary measures and nutritional supplements are not indicated as part of the treatment of early RA; (5) elimination diets, particularly those with low intakes of dairy products, should be discouraged in patients with early RA. CONCLUSION: These recommendations should help to improve practice uniformity and, ultimately, to improve the management of RA.
OBJECTIVE: To develop clinical practice guidelines for the use of nonpharmacological treatments in patients with early rheumatoid arthritis (RA), using the evidence-based approach and expert opinion. METHODS: A scientific committee used a Delphi prioritization procedure to select five questions. Evidence providing answers to the five questions was sought in the literature and presented to a panel of rheumatologists. The panel developed five detailed recommendations, filling gaps in evidence with their expert opinion. The strength of each recommendation was determined. RESULTS: Of the 565 publications retrieved by the literature review, 198 were included in the analysis. The five recommendations on nonpharmacological treatments for early RA were validated by a final vote among all participants. The recommendations are as follows: (1) physicians may decide to provide joint protection education to patients with potentially severe early RA, with the knowledge that structured joint protection programs have not been found effective; (2) physical exercise and sports can be recommended to patients with early RA; muscle strength exercises are advisable; (3) in patients with early RA, metatarsal pain and/or foot alignment abnormalities should be looked for regularly, and appropriate insoles should be prescribed if needed; (4) dietary measures and nutritional supplements are not indicated as part of the treatment of early RA; (5) elimination diets, particularly those with low intakes of dairy products, should be discouraged in patients with early RA. CONCLUSION: These recommendations should help to improve practice uniformity and, ultimately, to improve the management of RA.
Authors: Norma J Macintyre; Sydney C Lineker; Christina Hallett; Jake Tumber; Nalin Fernando; Magdalena Hul Journal: Physiother Can Date: 2012 Impact factor: 1.037
Authors: J Braun; A Krause; M Aringer; G Burmester; F Bessler; J-M Engel; U Faubel; R Fischer-Betz; E Genth; E Gromnica-Ihle; B Hellmich; I Kötter; K Krüger; J Lakomek; H-M Lorenz; B Manger; E Märker-Hermann; K Minden; U Müller-Ladner; J Rautenstrauch; S Rehart; G Riemekasten; M Rudwaleit; W Rüther; G Schett; F Schuch; H Schulze-Koops; C Specker; S Wassenberg; D Wiek; A Zink; M Schneider Journal: Z Rheumatol Date: 2016-05 Impact factor: 1.372
Authors: Ronaldo Garcia Rondina; Ricardo Andrade Fernandes de Mello; Valeria Valim; Rafael Burgomeister Lourenco; Elton Francisco Pavan Batista; Ronaldo de Oliveira Júnior Journal: Rheumatol Int Date: 2017-05-27 Impact factor: 2.631