Centre de recherche rhumatologique et thermal, 15, avenue Charles-de-Gaulle, 73100 Aix-les-Bains, France.
Joint Bone Spine. 2009 Dec;76(6):691-8. doi: 10.1016/j.jbspin.2009.01.017.
Because drugs do not halt joint destruction in rheumatoid arthritis (RA), non-drug treatments are an important adjunct to drug treatment. Establishing rules governing their use is difficult because treatment is multidisciplinary, complex, and difficult to assess. The aims of these guidelines were to (a) establish the indications for physical therapies and for educational, psychological, and other non-drug interventions, (b) address social welfare, occupational, and organizational issues.
A systematic literature search (MEDLINE, EMBASE, CINAHL, Pascal, Cochrane Library, HTA database) (1985-2006) was completed with information obtained from specialty societies and the grey literature. A review of the studies meeting inclusion criteria, with evidence levels, was used by a multidisciplinary working group (18 experts) to draft guidelines. Consensus was reached when evidence was lacking on key topics. The draft guidelines were scored by 60 peer reviewers, amended when necessary, and then validated by the HAS Board.
Of the 1819 articles retrieved, 817 were analysed and 382 cited in the report. Low-power randomized clinical trials constituted the highest level of evidence. Grade B guidelines (intermediate evidence level) concerned aerobic activities, dynamic muscular strengthening, and therapeutic patient education. Grade C (low evidence level) concerned use of rest orthoses or assistive devices, balneotherapy and spa therapy, self-exercise programmes, and conventional physiotherapy. Professional agreement (no scientific evidence) was reached for orthotic insoles and footwear, chiropody care, thermotherapy, acupuncture, psychological support, occupational adjustments, and referral to social workers.
Aerobic activities, dynamic muscular reinforcement, and therapeutic patient education are valuable in non-drug management of RA.
由于药物无法阻止类风湿关节炎（RA）的关节破坏，因此非药物治疗是药物治疗的重要辅助手段。由于治疗是多学科的、复杂的且难以评估，因此制定其使用规则具有一定难度。本指南的目的在于：（a）确定物理疗法和教育、心理及其他非药物干预的适应证；（b）解决社会福利、职业和组织问题。
对 MEDLINE、EMBASE、CINAHL、Pascal、Cochrane 图书馆和 HTA 数据库（1985-2006 年）进行了系统文献检索，并从专业学会和灰色文献中获取信息。使用满足纳入标准的研究进行综述，并由多学科工作组（18 位专家）对证据水平进行评估，以起草指南。在关键主题缺乏证据的情况下，通过达成共识来制定指南。将草案指南交由 60 位同行评审员评分，在必要时进行修改，然后由 HAS 委员会进行验证。
在检索到的 1819 篇文章中，对 817 篇进行了分析，并在报告中引用了 382 篇。低效能随机临床试验为最高证据级别。B 级指南（中级证据水平）涉及有氧运动、动态肌肉强化和治疗性患者教育。C 级（低证据水平）涉及休息矫形器或辅助器具、水疗和温泉疗法、自我锻炼计划以及传统物理治疗的使用。对矫形鞋垫和鞋、足病护理、热疗、针灸、心理支持、职业调整和转介给社会工作者的治疗达成了专业共识（无科学证据）。
有氧运动、动态肌肉强化和治疗性患者教育是 RA 非药物治疗中的宝贵方法。
