FRI0721-HPR EFFECTIVENESS OF NON-PHARMACOLOGICAL AND NON-SURGICAL INTERVENTIONS ON THE IMPACT OF RHEUMATOID ARTHRITIS: AN OVERVIEW OF REVIEWS
Authors: Eduardo Santos, Catia Duarte, Andrea Marques, Daniela Cardoso, João Apóstolo, P José Antonio, Da Silva, Maria Do Céu Barbieri-Figueiredo
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Impact of disease persists in many patients with rheumatoid arthritis (RA) even after inflammatory remission is achieved, requiring the need for adjunctive interventions targeting the uncontrolled domains of disease impact. Several systematic reviews have addressed nonpharmacologic interventions, but there is still uncertainty due to scarce or conflicting results or significant methodological flaws. <h3>Objectives</h3> To determine the effectiveness of non-pharmacological and non-surgical interventions upon the impact of RA. <h3>Methods</h3> A comprehensive search strategy for 13 databases and grey literature was developed. This review included quantitative systematic reviews that examined the effectiveness of non-pharmacological and non-surgical interventions of any form, duration, frequency and intensity, alone or in combination with other interventions designed to reduce the impact of disease in adult patients with RA. The outcomes were pain, functional disability, fatigue, emotional well-being, sleep, coping, physical well-being and global impact of disease. Critical appraisal and data extraction were performed independently by two reviewers and summarized using a narrative synthesis approach. <h3>Results</h3> Eight systematic reviews were included (Figure 1), with a total of 91 RCT's and nine observational studies (6740 participants). Four systematic reviews examined the effects of multicomponent or single exercise/physical activity interventions, two examined the effects of hydrotherapy/balneotherapy, two evaluated the effects of psychosocial interventions and one assessed the effects of custom orthoses for the foot and ankle. Multicomponent or single exercise/physical activity interventions, psychosocial interventions and custom orthoses appeared to be effective in improving pain and functional disability. Fatigue also improved with the implementation of multicomponent or single exercise/physical activity interventions and psychosocial interventions. Only exercise/physical activity interventions appeared to be the effective in improving the global impact of disease. None of the included systematic reviews reported on emotional well-being, sleep, coping or physical well-being as an outcome measure. Other types of interventions were not sufficiently studied and their effectiveness is not yet established. <h3>Conclusion</h3> Only multicomponent or single exercise/physical activity interventions, psychosocial interventions and custom orthoses seems to be capable of reducing the impact of rheumatoid arthritis. Future evidence should be created and synthesized in the fields identified as knowledge gaps, namely emotional well-being, sleep, coping and physical well-being. Further investigation should be encouraged on the effects of interventions that have not been assessed at all or sufficiently to established their effectiveness, so that robust decisions and recommendations can be made. <h3>Disclosure of Interests</h3> None declared