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Thoughts on the American College of Rheumatology's latest guidelines for RA

The American College of Rheumatology (ACR) is supposed to be the premier resource for patients suffering from rheumatological conditions and for practitioners treating those patients. The full guidelines will be released later this year, but the preliminary report has the following to say. I took some of the more notable highlights from the report and give my thoughts on them below.


The ACR has now released, for the first time, guidelines that focus on exercise, rehabilitation, diet, and additional integrative interventions for RA

For the first time?! Why are they waiting this long to discuss such vitally important information? Rheumatological conditions, such as RA are typically treated by rheumatologists by the use of pharmaceuticals. Little to no focus is put on any other treatment modality.

Those with RA are suffering with chronic pain but yet are getting poor treatments because the governing body is sticking with the pharmaceutical industry instead of you!

It is no surprise here to anyone in the complementary and alternative medical fields that A LOT can be done outside of pharmaceuticals to help people suffering. In fact, all of these alternative therapies are way more effective than drugs.

They are also touting that these guidelines will offer a more "personalized approach" to treating RA. I'm sorry, but nothing about a guideline says "personalized" to me.

The guideline includes 28 recommendations; only one recommendation was strong. Out of the 27 conditional recommendations, four were about exercise, 13 about rehabilitation, three about diet, and seven about additional integrative interventions.

Buckle up because this is about to get good.

The one strong recommendation states that consistent engagement in exercise is advised over no exercise. The type of exercise, frequency, intensity, and duration is not formally defined, but the guideline emphasizes moving regularly.

Starting off strong. I couldn't agree more with this. RA is painful, which makes any movement undesirable, especially exercise. But with any rheumatological condition, preserving and enhancing joint motion is crucial! It will be painful at first, but consistent movement and exercise will decrease pain. Not moving in order to avoid pain will actually produce more pain in the long run!

I don't care for the word "exercise" because I think it implies the use of equipment and having to make a time commitment. Instead I like to just say "movement." Getting as much movement in throughout the day is simple and less intimidating. Go for a walk, a hike, a bike ride, or dance in the kitchen. Whatever activity brings you joy and gets you moving is fantastic. Just do it on a regular basis!

Adherence to a Mediterranean-style diet is conditionally recommended. ACR also conditionally recommends against adhering to any other formally defined diet or to any specific dietary supplements.

The Mediterranean diet is a great diet. Those that do adhere to it typically live longer, healthier, disease free lives. But the reason for it is because it is a whole foods based diet, and a whole foods diet is the only diet humans should be eating. We don't get any benefit from processed foods, only detriment.

So those with RA will absolutely feel better on a Mediterranean diet, but it IS NOT the the best diet for them.

RA is an autoimmune disease but nobody treats it that way in conventional medicine. So why would anyone suggest against an autoimmune protocol diet? Dairy, gluten, sugar, corn, and soy to name a few are triggers to autoimmune diseases. The Mediterranean diet is heavy in grains (gluten) and dairy! The Mediterranean diet works much better in the Mediterranean but not here since our grains and dairy are hyper-inflammatory. Why do we want to add more inflammation to an inflammatory condition?!

You CANNOT put an autoimmune condition, including RA, into remission while eating dairy, gluten, and sugar. A big swing and miss from the ACR here.

To say that they recommend against any other type of diet is absurd. This panel of rheumatology experts don't know enough about nutrition. Nutrition is the STARTING PLACE for any autoimmune or inflammatory condition. Therefore, an emphasis on nutrition should be a strong recommendation with exercise, not a lesser conditional recommendation.

Um, and I'm sorry, you're recommending against supplementation? I guess supplementing with fish oil, turmeric, resveratrol, and probiotics to decrease inflammation is just a stupid idea I've had all these years? Magnesium as a muscle relaxer is probably a bad idea too?

ACR conditionally recommends: cognitive behavioral therapy (CBT) and/or mind-body approaches, acupuncture, massage therapy

Yes, this is great! The mind-body connection with chronic pain is well documented and the outcomes with a well trained chronic pain specialist in mind-body medicine are better!

Acupuncture is another great treatment that I am surprised to see getting recognition here. I wish I could speak more to the specific affects acupuncture has on RA but I do not know enough. I just know that adding acupuncture to your treatment plan can provide better outcomes!

Massage therapy is wonderful for RA. It helps get more motion into the joints and clears inflammation!

The organization conditionally recommends against: electrotherapy and chiropractic therapy

Oh no. ACR, what are you doing here?!

Chiropractic medicine is the absolute best way to preserve and enhance joint motion, even in RA! RA is not a contraindication to chiropractic care. Chiropractic care does not always mean adjustments either. Chiropractors specialize in movement so they can perform joint mobilizations and sit tissue therapies that help with movement. You know, the same movement you strongly recommend in your report!

Chiropractic care is safe and effective for rheumatological conditions. Maybe if there was a chiropractor on your "expert" panel you would have known this. There are currently no explanations for why chiropractic care is advised against by the ACR.

Also electrotherapy is a great modality for RA. It helps decrease pain, break up scar tissue, and move inflammation.


There you have it, the American College of Rheumatology's expert opinion on the treatment guidelines for RA.

What do you think?

I think that those at the top, placed in charge of giving you the most up to date research on RA, have failed you. These recommendations are why you are not putting your RA into remission and why your rheumatologists aren't giving you the best care possible.

The guidelines also failed to include some other wonderful therapies for RA and chronic pain, like cold laser, infrared sauna, and hydrotherapy. All things I have have been doing for years with my chronic pain patients which have been providing tremendous pain relief.

Next time they should broaden their horizons and get more help from practitioners in alternative and complementary medicine if they really want to write guidelines on integrative care for RA. Just consulting MDs and PTs is not integrative medicine.

You can read the report here.

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