Guideline for Integrative RA Interventions Released

For guidance on exercise duration, intensity, etc., the guideline suggests following recommendations from the U.S. Department of Health and Human Services for the general population.² However, Dr. England emphasizes that the recommendations should be adapted to patients’ individual needs, abilities and preferences, as well as their specific capacities on a given day.

Occupational & Physical Therapy

The guideline also contains a conditional recommendation for a course of occupational therapy for patients with RA. Such therapy can help individuals adapt daily activities to meet their needs and goals, provide education on managing fatigue and assist them in maintaining their desired work and leisure activities.³

Dr. Nancy A. Baker

Nancy A. Baker, ScD, MPH, OTR/L, is a professor in the Department of Occupational Therapy, Tufts University, Boston, who also worked on the integrative rheumatoid arthritis guideline. She points out that occupational therapists have a long history of helping patients with rheumatoid arthritis improve their overall function. However, many rheumatologists and other doctors stopped referring patients to occupational therapy after the development of methotrexate and later biologic disease-modifying anti-rheumatic drugs.

“We’ve discovered that [the medication-only] approach is incomplete,” says Dr. Baker. RA is a chronic disease. Although medications are certainly preventing the disease from damaging patients’ joints in many cases, people with RA still have a lot of problems to navigate. “In occupational therapy, we can provide people with tips and help them figure out how they can modify their lives so they can control the impact of the chronic disease on their everyday lives,” she continues.

Dr. Baker points out that people often develop RA in the middle of their working lives. Roughly a third of employed people with RA are not working within three years of their diagnosis, and that number reaches 50% within 10 years.⁴ Occupational therapy can be very helpful in finding strategies to help patients manage their pain and fatigue and adapt their working environment so they can continue their employment, she says.

The guideline also conditionally recommends a course of physical therapy for patients with RA. Physical therapy is focused more on building patients’ physical capacity, strength and overall muscle tone than occupational therapy, which is focused more on helping patients optimally use their existing capacity. Dr. Baker points out that physical therapists are ideally suited to help people with RA find ways to exercise safely.

The guideline conditionally recommends the use of assistive devices, adaptive equipment, environmental adaptations, activity pacing strategies, joint protection techniques and splinting or orthoses for selected patients. Both occupational and physical therapists can apply such tools and strategies in an individualized way. They may also employ other methods conditionally recommended in the guideline, such as thermal modalities or massage.