First look at lifestyle
recommendations for RMDs
The importance of lifestyle factors in RMDprogression is the subject of new EULARrecommendations to bepresented for the first timeby Dr. Suzanne Verstappen,of the Centre for Epidemiology Versus Arthritis in theCentre for MusculoskeletalResearch at University ofManchester (United Kingdom). The reason for theseis that patients often askhealthcare professionals forinformation on what theycan do to help reduce theimpact of their disease, butthere is little guidance tohelp clinicians give an appropriate answer,she explained in an interview.
“There are quite a lot of leaflets available from patient and health professionalorganisations, but the information is oftennot based on scientific evidence,” Dr.
Verstappen said. “What we wanted to do
is come up with some recommendations
based on scientific evidence.”
In addition, the aim was to focus on spe-
cific rheumatic diseases – osteoarthritis,
RA, ankylosing spondylitis, systemic lupus
erythematosus, gout, PsA, and systemic
sclerosis – rather than
RMDs generally. This was
“because there may be a
difference when thinking,
for example, about phys-
ical activity – should a
recommendation be similar
between somebody with
osteoarthritis and some-
body with ankylosing spon-
The new guidance
consists of 5 overarching
principles and 18 recom-
mendations that cover six
main lifestyle “exposures” – diet, smoking,
alcohol, weight, work, and physical activi-
ty. These recommendations are in addition
to any pharmacologic treatment, not a
replacement, she was keen to stress.
With regards to diet, there is no evidence to show that any particular dietwill help limit the progression of an RMD.
Most studies included a small number ofpatients, and where larger studies havebeen conducted (e.g., vitamin D for OA;marine oil/omega 3 for RA) only small effect sizes were reported that are unlikelyto be clinically meaningful. In general, it isimportant that patients with RMDs are encouraged to maintain a healthy, balanceddiet. Other recommendations cover stopping smoking, limiting alcohol intake, andmanaging a healthy weight.
Physical activity is recommended for
most patients “you don’t really see any
adverse events for physical activity, so
it’s good for people to exercise,” she said.
“Strengthening and aerobic exercises were
especially good for patients, with strong
evidence for ankylosing spondylitis and
The task force behind the lifestyle rec-
ommendations found hardly any research
on lifestyle factors and systemic sclerosis
and systemic lupus erythematosus, how-
ever, “so I think for the future, for these
specific diseases, there needs to be a bit
more research about the impact of these
lifestyle factors on disease progression,”
Dr. Verstappen said.
Continued from page 7
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