Implementation Practices for the 2022 American College of Rheumatology Guidelines for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis

Abstract

Background: Given the significant burden of metabolic and functional diseases in rheumatoid arthritis, the American College of Rheumatology (ACR) released lifestyle guidelines in 2022 for exercise,
rehabilitation, diet, and additional interventions in rheumatoid arthritis. This study aimed to investigate real-world implementation post-guidelines to identify gaps in adherence, as well as future directions for guideline-based interventions.

Methods: A retrospective chart review of adult patients presenting to the rheumatology department
was performed at the institution between November 15, 2022, and February 15, 2023, the 3 months
immediately following guideline release. Information on demographics, comorbidities, disease control, and immunomodulatory therapy was obtained. Referral patterns for physical therapy, occupational therapy, and behavioral health were reviewed, as well as recommendations for exercise and a
Mediterranean diet. The baseline referral patterns were also examined in the year prior to guideline
release for both rheumatology and non-rheumatology providers.

Results: This study included 791 individuals. In the post-guideline period, 3.5% of the patients received
recommendations for an exercise program from a rheumatology provider, and 3.2% and 0.5% received
referrals to physical therapy (PT) and occupational therapy (OT), respectively. Post-guideline dietary
recommendations for the Mediterranean diet were provided to 0.5% of patients, while referrals to
weight loss clinics and behavioral health services were less frequent, each being 0.1%.

Conclusion: At 3 months post-guideline release, adherence to the 2022 ACR lifestyle guidelines was
low. Additional guideline education for providers and a reduction in barriers to implementation are
needed.

Cite this article as: Nichols L, Nickell
A, Wold E, Sahmoun AE, Scheibe M.
Implementation practices for the 2022
American College of Rheumatology
guidelines for exercise, rehabilitation,
diet, and additional integrative
interventions for rheumatoid arthritis.
Eur J Rheumatol. 2025, 12(3), 0061, doi:
10.5152/eurjrheum.2025.24061.