Non-pharmacological treatment in difficult-to-treat rheumatoid arthritis

Although the management of rheumatoid arthritis (RA) has improved remarkably with new pharmacological therapies, there is still a significant part of patients not reaching treatment goals. Difficult-to-treat RA (D2TRA) is a complex entity involving several factors apart from persistent inflammation, thereafter requiring a holistic management approach. As pharmacological treatment options are often limited in D2TRA, the need for non-pharmacological treatments (NPT) is even more pronounced. The mechanism of action of non-pharmacological treatments is not well investigated, NPTs seem to have a complex, holistic effect including the immune, neural and endocrine system, which can have a significant additive benefit together with targeted pharmacotherapies in the treatment of D2TRA. In this review we summarize the current knowledge on different NPT in rheumatoid arthritis, and we propose a NPT plan to follow when managing D2TRA patients.

Automated summary

Although significant progress has been made in the pharmacological treatment of rheumatoid arthritis (RA), a considerable number of patients still do not achieve treatment goals. Non-pharmacological treatments (NPTs) play a crucial role, especially in difficult-to-treat RA (D2TRA), where pharmacological options are often limited. NPTs seem to have a complex, holistic effect that can complement targeted pharmacotherapies in the treatment of D2TRA.