If you’re living with rheumatoid arthritis (RA), you likely know the importance of using disease-modifying anti-rheumatic drugs (DMARDs) to manage your condition and safeguard your joints from further harm. But should you also consider incorporating exercise, nutrition, rehabilitation, and other integrative approaches into your treatment plan? A brand-new recommendation from the American College of Rheumatology (ACR) suggests that you should, with a particular emphasis on the role of exercise. 

In an effort to offer people with RA and their health care providers science-based guidance on this subject, the ACR released its very first set of recommendations on integrative treatments for rheumatoid arthritis. 

It’s important to note that while integrative treatment can offer holistic benefits, it should be done under the guidance and supervision of qualified health care professionals to ensure safe and effective management of RA. Patients are encouraged to work closely with their health care providers to develop a personalized treatment plan that combines the most effective elements of both conventional and complementary therapies.  

Applying the Guideline to Your Lifestyle

We spoke with Jeffrey Curtis, MD, MS, MPH, Executive Director at the Foundation for Advancing Science, Technology, Education and Research and Chief Medical Informatics Officer, Illumination Health, about the four recommendations within the Integrative RA Treatment Guideline and what this information means for patients.  

The Integrative RA Treatment Guideline encompasses four main intervention categories: exercise, rehabilitation, dietary, and additional integrative therapies. Here, Dr. Curtis addresses how exercise and diet can play a role in a patient’s treatment plan. 

CJ: Why are these guidelines important for patients? 
Dr. Curtis: “The guidelines are important because they allow patients to be more participatory in their own care. Patients by themselves are not going to be prescribing and taking a new medicine, they are going to work with their rheumatology provider to do that. But many of the things in this guideline, for example diet or exercise, are things that patients can do on their own.” 

Strong vs. Conditional Recommendations

CJ: What is the difference between a strong or conditional recommendation in this guideline?
Dr. Curtis: “The ACR guideline presents recommendations that are either strong or conditional. A conditional recommendation means that some patients might think this is a good idea or that it’s suitable for them. But for others, it might not be the best choice and patient preference and someone’s own medical situation and circumstances have a large influence on the recommendations.”  

CJ: How should patients approach the guideline with their providers?
Dr. Curtis: “I encourage both providers and patients to read the guideline. That conditional part means that you should talk to your provider or consider your own circumstances about what you can do you now, what might be workable or most effective, or frankly, something that you think that you’ll adhere to and be able to keep doing over time.” 

Exercise for People with Inflammatory Arthritis

CJ: We know the importance of exercise for those living with inflammatory arthritis. But we also know that movement can be particularly difficult for those living with these conditions. Do you have any suggestions for how someone who maybe may be experiencing pain from inflammatory arthritis can make exercise work for them? 
Dr. Curtis: “I’m a big fan of aquatic exercise — pool therapy or pool exercise. Water cushions the joints so for somebody who might have degenerative arthritis or a lot of damage in their joints, because they’ve been living with the disease a long time, the water provides a great buffer that lets you be active, burn calories, work toward that healthy body weight, but it’s not planet Earth’s gravity on all of those joints.” 

CJ: What if you don’t have time or energy for a full-length workout?
Dr. Curtis: “The recommendation said that the ACR panel strongly recommends consistent exercise over no exercise. Something is always better than nothing,” says Dr. Curtis. “Even if you can do 10 minutes a day, three times a day, I’ll take that over nothing. Is that the same as one hard intense 30-minute workout? Maybe not. But is it a whole lot better than nothing? Absolutely. So, you know, five or 10 minutes several times a day? I would absolutely encourage people to do that and not feel like it’s so little.” 

Decreasing Inflammation through Diet

CJ: The guideline conditionally recommends the Mediterranean-style diet over other diet plans. What makes a Mediterranean-style diet more beneficial than other diets for people with rheumatoid arthritis?
Dr. Curtis: “This [diet] emphasizes vegetables and fruits, whole grains, nuts, olive oil, things like that, and kind of de-emphasizes added sugar and salt and highly processed foods and saturated fats. So this was a conditional recommendation — again ‘conditional’ meaning right for some people, but not for everybody across the board in every situation. The evidence is relatively low, but this one does have the strongest evidence for any type of diet.” 

CJ: What types of foods are recommended on this diet and why could this be beneficial to people with inflammatory conditions? 
Dr. Curtis: “Fill your meal plan with low-fat dairy, fish in moderation, whole grains, olive oil, vegetables, fruits, things that often are low calorie. Those are the things that would be the essential elements of the Mediterranean diet. I always strongly encourage maintaining a healthy body weight. Obesity is associated with disease activity, impaired and worsened physical function, and in many studies, worse treatment response to RA medications. And so, as part of a diet, not only to focus on the Mediterranean diet elements and the inflammation aspect, but also to think about maintaining a healthy body weight. Thankfully, the Mediterranean diet makes it easier to do that compared to maybe some of the other approaches that might have more difficulty with people’s adherence long-term.”  

Guideline Application Takeaways for Your Wellness Plan

As you consider incorporating the Integrative RA Treatment Guideline into your wellness plan, it’s essential to talk with your doctor about potential changes, particularly in your exercise and diet routines.  

Here are some key takeaways to keep in mind: 

  • Consult your doctor about exercise. For example, ask about exercise options that do not put extra strain on joints. Your doctor may be able to help you decide what type of exercise, duration, frequency, and intensity will be best for you. “Figure out what you can do —what works for you — and try to consistently engage with it,” reminds Dr. Curtis. “And don’t be discouraged if you don’t hit your goals with frequency or intensity. Part of what you’re doing is building a habit.” 
  • Think some exercise over no exercise. Again, the guideline states “consistent engagement in exercise over no exercise based on moderate certainty evidence suggesting that regular exercise results in improved physical function and pain in individuals with RA.”  In other words, a short walk or 10 minutes of exercise is better than doing nothing. Even if you cannot get in a full-length workout, shorter workouts or walks can still be beneficial. Consider aerobic, aquatic, or mind-body exercise, per the ACR. 
  • Focus on whole foods, limit the processed stuff. The Mediterranean-style diet is an anti-inflammatory diet that emphasizes the intake of “vegetables, fruits, whole grains, nuts, seeds, and olive oil and the intake of moderate amounts of low-fat dairy and fish, and limits the use of added sugars, sodium, highly processed foods, refined carbohydrates, and saturated fats,” and is conditionally recommended for people with RA over other diet plans.  

Want to Get More Involved with Patient Advocacy? 

The 50-State Network is the grassroots advocacy arm of CreakyJoints and the Global Healthy Living Foundation, comprised of patients with chronic illness who are trained as health care activists to proactively connect with local, state, and federal health policy stakeholders to share their perspective and influence change. If you want to effect change and make health care more affordable and accessible to patients with chronic illness, learn more here. 

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