Effectiveness of Nonpharmacological and Nonsurgical Interventions for Patients With Rheumatoid Arthritis: An Overview of Systematic Reviews

Abstract

Conclusions based on systematic reviews of randomized controlled trials are considered to provide the highest level of evidence about the effectiveness of an intervention. This overview summarizes the available evidence from systematic reviews on the effects of nonpharmacological and nonsurgical interventions for rheumatoid arthritis (RA). Systematic reviews of studies of patients with RA (aged >18 years) published between 2000 and 2007 were identified by comprehensive literature searches. Methodological quality was independently assessed by 2 authors, and the quality of evidence was summarized by explicit methods. Pain, function, and patient global assessment were considered primary outcomes of interest. Twenty-eight systematic reviews were included in this overview. High-quality evidence was found for beneficial effects of joint protection and patient education, moderate-quality evidence was found for beneficial effects of herbal therapy (gamma-linolenic acid) and low-level laser therapy, and low-quality evidence was found for the effectiveness of the other interventions. The quality of evidence for the effectiveness of most nonpharmacological and nonsurgical interventions in RA is moderate to low.

Long-Term Effects of Comprehensive Inpatient Rehabilitation on Function and Disease Activity in Patients with Chronic Rheumatoid Arthritis and Ankylosing Spondylitis

“…The complementary role of rehabilitation is supported by a number of systematic reviews and umbrella reviews for the management of RA [3,10,13,16,18] and AS. [18,19,21,31,41] International guidelines, including the ones developed by the ACR guidelines on RA, [1] and the Assessment of Spondylo Arthritis International Society (ASAS) and the European League Against Rheumatism (EULAR) recommendations on AS [42] also endorse the use of non-pharmacological interventions as an adjunct.…”

“…There were a limited number of systematic reviews for physical therapy with RA and AS. [2][3][4]19] High-quality evidence for joint protection and patient education, intermediate-quality evidence for aerobic activities, dynamic strengthening and lowquality evidence for conventional physiotherapy such as paraffin wax baths, ultrasound, and transcutaneous nerve stimulator (TENS) for hands, comprehensive occupational therapy, and exercises were reported in an overview of systematic reviews, the Ottawa Panel, and clinical practice guidelines for the nonpharmacologic treatments of RA. [2][3][4] However, there were no therapeutic ultrasound and TENS studies for rheumatoid knees despite their common usage in treatment.…”

“…Rheumatologic rehabilitation aims to prevent physical impairment and restore functional ability through the use of education, exercise, aids for daily living and mobility, and physical modalities. [3,4] Despite widespread positive clinical experience with rehabilitative interventions, the scientific evidence for their effectiveness is, in general, scanty due to a lack of studies with sufficient methodological quality. There is various data about the impact of different parts of rehabilitation in RA [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] and AS.…”

“…There is various data about the impact of different parts of rehabilitation in RA [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] and AS. [18][19][20][21][22][23][24][25][26][27][28][29][30][31] These parts consisted of education, [8,17] manual therapy, [27] exercises, [5,6,[12][13][14][15]22,25,26,28] PT, [3,16,19] OT, [9,20,24] and whole rehabilitation approaches [7,…”

“…Both diseases progress and lead to chronic pain and prominent disability. [1][2][3][4] The treatments of RA and AS should be multidisciplinary and include pharmacologic and nonpharmacologic interventions. Rheumatoid arthritis should now be considered as an immunologic emergency in which early and aggressive disease-modifying antirheumatic drugs (DMARDs) intervention is considered for the suppression of disease activity and preservation of articular structure and in turn function.…”