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

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Rheumatology Advance Access published online on June 24, 2007

Rheumatology, doi:10.1093/rheumatology/kem149

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Review

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

Theodora P. M. Vliet Vlieland

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

Netherlands

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.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kem149v1

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