Nonpharmacological treatments in early rheumatoid arthritis: clinical practice guidelines based on published evidence and expert opinion.
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.


CONCLUSIONS
These recommendations should help to improve practice uniformity and, ultimately, to improve the management of RA.
Gossec
Laure
L
Service de rhumatologie B, CHU de Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France.
Pavy
Stephan
S
Pham
Thao
T
Constantin
Arnaud
A
Poiraudeau
Serge
S
Combe
Bernard
B
Flipo
René-Marc
RM
Goupille
Philippe
P
Le Loët
Xavier
X
Mariette
Xavier
X
Puéchal
Xavier
X
Wendling
Daniel
D
Schaeverbeke
Thierry
T
Sibilia
Jean
J
Tebib
Jacques
J
Cantagrel
Alain
A
Dougados
Maxime
M
D001172:Arthritis, Rheumatoid / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D026741:Physical Therapy Modalities; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome