EULAR offers lifestyle guidelines to curtail rheumatic, musculoskeletal disease progression
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Lifestyle approaches, including physical activity and smoking cessation, should complement medical therapy in patients with rheumatic and musculoskeletal diseases, according to data presented at the EULAR 2020 E-Congress.
Suzanne Verstappen, MD, of the division of musculoskeletal and dermatological sciences at the University of Manchester in the U.K., noted that guidelines for the general population encourage a healthy and balanced diet, limited alcohol intake, regular exercise and smoking cessation to prevent chronic disease. “However, these guidelines for the general population are not included in our strategies to prevent the progression of rheumatic and musculoskeletal diseases, or RMDs,” she said.
With that in mind, the task force queried several professional and patient health organizations around Europe about approaches to lifestyle interventions and documentation they use to monitor those approaches. “There was a lot of variation across countries,” Verstappen said. “There was variation in the content. Some were very disease-specific, some generic.”
The task force then aimed to develop recommendations for healthy lifestyle strategies to prevent progression of RMDs, including osteoarthritis, rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis (PsA), systemic scleroderma, lupus and gout.
Exposures that underwent analysis included smoking, diet, physical activity, work, weight and alcohol consumption. “For each of these exposures, we looked at the association of the progression of the disease, including joint damage, fatigue, functional ability, disease activity and comorbidities,” Verstappen said.
After a thorough literature review, the task force arrived at five over-arching principles and 18 recommendations. “For some of the diseases, limited information was available,” Verstappen said. “Overall, there was a large variation in the quality of the studies.”
Of the 18 recommendations, Verstappen noted that there were “seven for exercise, two for diet, two for weight, four for alcohol, two for smoking and one for work.” She acknowledged that some are generic, while others are disease specific.
“For physical activity, people with rheumatic and musculoskeletal diseases (RMDs) should perform both aerobic and strengthening exercises,” Verstappen said. “It is never too late to start.”
Diet should be “healthy and balanced,” while the decision about what constitutes a healthy weight should be shared between the patient and a multidisciplinary team of physicians, according to Verstappen. “When people lose or gain weight, adjustment of medications should be considered,” she said.
Alcohol consumption should be moderate. Patients with gout, in particular, should limit alcohol intake as it has been associated with flare of that disease.
“Individuals with RMDs should be encouraged to stop smoking,” Verstappen continued, noting that smoking may impact DMARD response in patients with RA.
As for work, Verstappen suggested that the data did not demonstrate a detrimental impact of work on disease progression.
In commenting about the over-arching principles, Verstappen highlighted the first. “Lifestyle approaches should complement medical treatment,” she said.
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Verstappen S, et al. Recommendations for lifestyle behaviour to prevent progression of Rheumatic and Musculoskeletal Diseases. Presented at: EULAR 2020 E-Congress; June 3-6, 2020 (virtual meeting).
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