Table 7.

Research agenda for the integrative management of rheumatoid arthritis.

Evaluate the efficacy and safety of integrative therapies for the management of RA. Initial evidence is needed in the areas of activity pacing, energy conservation, activity modification, fatigue management, and vocational rehabilitation. Additional strong evidence from larger, well-designed studies is needed in all other areas.

Determine the appropriate timing of different integrative interventions in the RA disease course.

Examine the delivery, education, and implementation of integrative interventions. For example, evaluating various methods of instruction and training of joint protection and activity pacing interventions.

Establish the cost-effectiveness of different integrative interventions and develop approaches for cost-effective delivery.

Identify barriers to the adoption and implementation of integrative therapies. These may include variability in access, costs, and implicit and/or explicit biases.

Describe the assembly of, communication between, and role delineation among the interprofessional care team delivering pharmacologic and integrative interventions.

Improve access to experienced healthcare professionals who provide integrative interventions.

Determine efficacy and safety of integrative interventions based on RA disease manifestations and pharmacologic therapies, e.g., modifying exercise interventions based on disease activity level or diet based on disease-modifying anti-rheumatic drugs utilized.

Tailor interventions (and their delivery) studied in the general population to persons with RA, e.g., tobacco cessation programs, exercise programs, and weight loss.

Define efficacy and safety of therapies not included in this guideline such as cannabidiol, vaping, and occupational exposures and protections as well as emerging therapies such as vagal nerve stimulation.

Evaluate dietary supplements (especially Vitamin D and Omega-3 fatty acids such as “fish oil”) in the context of dietary intake. The assessment and implementation of diets should focus on being inclusive of different cultures.

Develop vocational rehabilitation programs and work site modifications that improve the ability of persons with RA to work without negative stigma in the workplace.

Establish the efficacy and safety of integrative therapies on extra-articular manifestations and long-term RA-related outcomes. In addition to disease activity, physical function, pain, and quality of life outcomes considered in this guideline, other outcomes that should be considered are longevity, cardiovascular disease, lung disease, cancer, osteoporosis, and infection.

Develop research methodology to study integrative therapies, e.g., defining an adequate control intervention. Publication of research standards for integrative therapies relevant to RA to guide research efforts.

Establish dedicated funding from organizations to study integrative RA therapies and their implementation.