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Rheumatology Advance Access originally published online on June 24, 2007
Rheumatology 2007 46(9):1397-1404; doi:10.1093/rheumatology/kem149
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

REVIEWS

Non-drug care for RA—is the era of evidence-based practice approaching?

T. P. M. Vliet Vlieland

Department of Rheumatotlogy, C1-R, Leiden University Medical Center, The Netherlands.

Correspondence to: Theodora P.M. Vliet Vlieland, MD, PhD, Associate Professor, Department of Rheumatology, C1-R, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands. E-mail: t.p.m.vliet_vlieland{at}lumc.nl


  Abstract

Non-pharmacological treatment modalities are often recommended, prescribed and used in addition to drug treatment in patients with rheumatoid arthritis (RA). This article provides a review of the literature on their effectiveness.

Currently, a considerable number of systematic reviews summarising the available studies for non-drug care interventions in RA are available. The evidence of effectiveness varies among the different non-pharmacological modalities, with relatively strong support for exercise and self-management interventions, and modest support for joint protection programmes, specific orthoses and comprehensive care interventions. Overall, the evidence for effectiveness of massage and electro-physical modalities is absent or weak. In general, few studies in patients with early RA, studies comparing different attributes of non-pharmacological modalities or comprehensive care models and economic evaluations have been performed, so that the optimal timing, intensity, duration and mode of delivery often remain unclear.

The results of this review indicate a need for further investigation into the most clinically and cost-effective strategies to deliver individual non-pharmacological treatment modalities as well as comprehensive arthritis service delivery models for RA patients in different stages of the disease.

KEY WORDS: Rheumatoid arthritis, Physical therapy, Exercise, Thermotherapy, Physical modalities, Occupational therapy, Orthoses, Assistive devices, Joint protection, Vocational rehabilitation

Submitted 15 January 2007; revised version accepted 27 April 2007.
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