EULAR: Exercise ‘should be considered’ for patients with lupus, systemic sclerosis
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Key takeaways:
- EULAR has released new recommendations for non-pharmacologic management of lupus and systemic sclerosis.
- The new guideline includes recommendations encouraging physical exercise for patients with either disease.
Physical exercise “should be considered” in patients with either systemic lupus erythematosus or systemic sclerosis, according to new EULAR recommendations on non-pharmacologic management published in the Annals of the Rheumatic Diseases.
“Non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) is helpful but unstandardized and often underused in current clinical practice,” Ioannis Parodis, MD, MPH, of the Karolinska Institute, in Sweden, told Healio. “Hence, we developed recommendations to provide guidance for non-pharmacological management of people living with SLE and SSc.”
To formulate recommendations for non-pharmacological interventions in patients SLE and SSc, Parodis and colleagues established a steering committee and EULAR task force. The task force included seven rheumatologists, 15 other health care providers and three patients. Members completed two systematic literature reviews, one regarding non-pharmacological interventions in patients with SLE, and the other in patients with SSc.
Following the literature reviews, overarching principles and recommendations were presented at four virtual meetings in May 2022 and June 2022. Task force members voted on the recommendations, and upon reaching 75% agreement during the first round of voting, adopted the recommendations. The adoption threshold lessened in the second round of voting, to 66% agreement, and again in the third round, to 50% agreement.
In all, the task force identified four overarching principles, five recommendations for patients with SLE or SSc, four recommendations specifically focusing on SLE and three recommendations focusing on SSc.
Recommendations regarding patients with SLE or SSc include:
- Non-pharmacological measures should target the improvement of health-related quality of life.
- Patients with either disease should receive support regarding self-management and patient education.
- Patients who smoke should be counseled to quit.
- Patients with either disease should take measures to protect themselves against the cold; patients with SSc should take extra care.
- Physical exercise “should be considered” in patients with either SLE or SSc.
For patients with SLE, the following recommendations were adopted:
- Patient education and self-management support should be considered to improve the efficacy and longevity of practicing physical exercise.
- Patients should be advised to use sun protection.
- Patients should consider implementing psychosocial interventions for the sake of health-related quality of life as well as addressing anxiety and depression.
- Aerobic exercise may be beneficial in improving capacity for fatigue and symptoms of depression.
Finally, the following recommendations were adopted for patients with SSc:
- Patients should be offered education and management support to improve various outcomes, including those involving their hands, mouth and health-related quality of life scores.
- Patients should consider following hand, aerobic and orofacial exercises to improve physical function outcomes.
- Patients with “puffy” hands should consider lymph node drainage.
“Briefly, non-pharmacological management of SLE and SSc should be tailored, person-centered, and participatory,” Parodis said. “It is not intended to preclude but rather complement pharmacotherapy. These recommendations will provide guidance on non-pharmacological interventions in the management of SLE and SSc in clinical practice and promote their use alongside pharmacotherapy to improve the overall quality of care.”
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