Non-pharmacological treatment in difficult-to-treat rheumatoid arthritis

Judit Majnik; Noémi Császár-Nagy; Georgina Böcskei; Tamás Bender; György Nagy

doi:10.3389/fmed.2022.991677

Non-pharmacological treatment in difficult-to-treat rheumatoid arthritis

Front Med (Lausanne). 2022 Aug 29:9:991677. doi: 10.3389/fmed.2022.991677. eCollection 2022.

Authors

Judit Majnik^{1

2}, Noémi Császár-Nagy³, Georgina Böcskei², Tamás Bender², György Nagy^{1

4

5

6}

Affiliations

¹ Department of Rheumatology and Clinical Immunology, Semmelweis University, Budapest, Hungary.
² Hospital of the Hospitaller Order of Saint John of God, Budapest, Hungary.
³ Department of Public Management and Information Technology, Faculty of Science of Public Governance and Administration, National University of Public Service, Budapest, Hungary.
⁴ Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary.
⁵ Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
⁶ Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary.

Abstract

Although the management of rheumatoid arthritis (RA) has improved remarkably with new pharmacological therapies, there is still a significant part of patients not reaching treatment goals. Difficult-to-treat RA (D2TRA) is a complex entity involving several factors apart from persistent inflammation, thereafter requiring a holistic management approach. As pharmacological treatment options are often limited in D2TRA, the need for non-pharmacological treatments (NPT) is even more pronounced. The mechanism of action of non-pharmacological treatments is not well investigated, NPTs seem to have a complex, holistic effect including the immune, neural and endocrine system, which can have a significant additive benefit together with targeted pharmacotherapies in the treatment of D2TRA. In this review we summarize the current knowledge on different NPT in rheumatoid arthritis, and we propose a NPT plan to follow when managing D2TRA patients.

Keywords: difficult-to-treat; exercise; non-pharmacological; physiotherapy; psychotherapy; rheumatoid arthritis; treatment.

Publication types

Review