2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis

Bryant R. England, Benjamin J. Smith, Nancy A. Baker, Jennifer L. Barton, Carol A. Oatis, Gordon Guyatt, Allen Anandarajah, Kristine Carandang, Karmela Kim Chan, Deb Constien, Eileen Davidson, Carole V. Dodge, Anita Bemis-Dougherty, Sotiria Everett, Nadine Fisher, Liana Fraenkel, Susan M. Goodman, Janet Lewis, Victoria Menzies, Larry W. MorelandIris Navarro-Millan, Sarah Patterson, Lawrence “Rick” Phillips, Neha Shah, Namrata Singh, Daniel White, Rawan AlHeresh, Kamil E. Barbour, Thomas Bye, Dana Guglielmo, Rebecca Haberman, Tate Johnson, Anatole Kleiner, Chris Y. Lane, Linda C. Li, Hiral Master, Daniel Pinto, Janet L. Poole, Kimberly Steinbarger, Daniel Sztubinski, Louise Thoma, Vlad Tsaltskan, Marat Turgunbaev, Courtney Wells, Amy S. Turner, Jonathan R. Treadwell

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA). Methods: An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. Results: The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions. Conclusion: This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team-based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision-making when applying these recommendations.

Original languageEnglish (US)
Pages (from-to)1299-1311
Number of pages13
JournalArthritis and Rheumatology
Issue number8
StatePublished - Aug 2023

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology


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