RecommendationsNon-drug treatment (excluding surgery) in rheumatoid arthritis: Clinical practice guidelines
Introduction
Rheumatoid arthritis (RA) is a chronic, inflammatory rheumatic condition that results in joint destruction. Recent progress has led to the use of drugs that curb the onset and progression of structural lesions but that do not halt the disease. Physical management is therefore potentially useful as an adjunct to medical and surgical treatment. Its main aim is to reduce pain, prevent and contain joint destruction, prevent the loss of function in daily activity and at work, and optimise quality of life [1].
Many non-drug treatments of RA are available but there are few rules governing their use. Because these treatments are difficult to assess, the literature is sparse. Our aim was to establish practice guidelines based on a systematic review of the available literature and the consensus opinion of a multidisciplinary working group of experts. These guidelines should help patients with RA gain access to appropriate and coordinated management, whether relating to treatment or to social welfare and employment issues, and should facilitate the harmonization of the organisation of care.
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Method
The guidelines were produced using a method developed by the Haute Autorité de Santé (HAS) [2]. A working group drafted the guidelines, which were submitted to external peer review and then validated by the HAS Board.
The following databases were searched over the period 1985–2006: MEDLINE, EMBASE, CINAHL, Pascal, Cochrane Library, National Guideline Clearinghouse, HTA database, and PEDRO. The keywords were “arthritis OR rheumatoid, rheumatoid arthritis” AND “guidelines OR practice guidelines OR
Results
A total of 1819 articles were retrieved, of which 817 were analysed and 383 were cited in the evidence report. The main reasons for article rejection were: article not meeting one of the inclusion criteria, article that was a general review, article rejected in an earlier well-conducted systematic review, and article with no clinical data.
Recommended treatments are summarized in Table 1. A grade is given for each indication. The full evidence report is available on the HAS website (//www.has-sante.fr/
Conclusion
The critical review of the literature has revealed the value of aerobic activity and active muscle strengthening in patients with RA [35]. These were not advised in France in the past but, in view of the evidence that has been generated, are now recommended. The review also revealed the value of patient therapeutic education.
The present recommendations for non-drug management of RA have considered therapeutic objectives, expected disease course, and disease progression. Physical treatments,
Conflicts of interest
The authors have no conflicts of interest to declare.
Acknowledgements
The HAS thanks all the health professionals and patient representatives who helped develop these guidelines (see Appendix B, for list).
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