First-ever ACR guidelines recommending integrative approach for the management of rheumatoid arthritis released

The American College of Rheumatology (ACR) has released its first-ever integrative approach for the management of rheumatoid arthritis (RA) and the new guidelines include recommendations for exercise, rehabilitation, diet, and additional integrative interventions. The details of the new guidelines, which will complement the ACR’s 2021 guideline for the treatment of RA, are expected to be published in reputed journals in early spring 2023.

In order to draft the guidelines, a literature review team has conducted a systematic literature review and graded the existing research based on the quality and certainty of evidence. An interprofessional voting panel, comprising health experts from different medical specialties finalized the recommendations; and classified them as ‘strong’ or ‘conditional’, depending on the level of available evidence.

Out of the 27 conditional recommendations enlisted in the guidelines, the number of recommendations for exercise, rehabilitation, diet, and integrative interventions are 4, 13, 3, and 7 respectively. As per one of the strong recommendations, regular engagement in exercise is recommended over no exercise.

Although the guidelines have not formally defined the exercise, frequency, intensity, and duration, it has highlighted the significance of the regular movement. The guidelines have also emphasized tailoring specific elements of exercise intervention as per the disease trajectory, patient’s capabilities, access, and health conditions.

The guidelines also have conditional recommendations favoring adherence to a Mediterranean-style diet over no formally defined diet. The Mediterranean-style diet recommends the consumption of fruits, whole grains, nuts, vegetables, seeds, and olive oil; moderate low-fat dairy and fish; and restricting the intake of sugars, sodium, refined carbohydrates, highly processed foods, and saturated fats. The guidelines have conditionally recommended dietary supplements, chiropractic therapy, and electrotherapy.

The summary of the new guidelines/recommendations is available at the official site at


New Guideline Introduces Recommendations for Integrative Approach to RA Treatment [Internet]. [cited 2023 Jan 17]. Available from: