title: Nonpharmacological treatments in early rheumatoid arthritis: clinical practice guidelines based on published evidence and expert opinion.
abstract: 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.
authors.affiliation: Service de rhumatologie B, CHU de Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
authors.forename: Stephan
authors.initials: S
authors.lastname: Pavy
authors.forename: Thao
authors.initials: T
authors.lastname: Pham
authors.forename: Arnaud
authors.initials: A
authors.lastname: Constantin
authors.forename: Serge
authors.initials: S
authors.lastname: Poiraudeau
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
authors.forename: René-Marc
authors.initials: RM
authors.lastname: Flipo
authors.forename: Philippe
authors.initials: P
authors.lastname: Goupille
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Loët
authors.forename: Xavier
authors.initials: X
authors.lastname: Mariette
authors.forename: Xavier
authors.initials: X
authors.lastname: Puéchal
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
authors.forename: Thierry
authors.initials: T
authors.lastname: Schaeverbeke
authors.forename: Jean
authors.initials: J
authors.lastname: Sibilia
authors.forename: Jacques
authors.initials: J
authors.lastname: Tebib
authors.forename: Alain
authors.initials: A
authors.lastname: Cantagrel
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
mesh_terms: 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