Nonpharmacological treatment in established rheumatoid arthritis.

The goals in the management of established rheumatoid arthritis (RA) are to control pain and disease activity, prevent further joint damage, and enhance functioning and quality of life. Despite the fact that aggressive and the early use of biological and nonbiological disease-modifying antirheumatic drugs have been associated with substantial gains in clinical, radiological, and disability outcomes, a considerable proportion of patients still report significant problems of physical, emotional and social functioning, and unmet needs in established RA. Therefore, nonpharmacological treatments are also administered for patients with RA. The aim of this article is to overview the nonpharmacological, therapeutical, and rehabilitative interventions, to minimize the consequences of the disease in patients with established RA. First, the principles of functional assessment in RA will be addressed. Then nonpharmacological interventions including therapeutic patient education, exercise therapy, physical modalities, orthoses, assistive devices, dietary interventions, and balneotherapy will be reviewed in the light of evidence-based literature data.