價Check for updatesArthritis RheumatologyAMERICAN COLLEGEVol.0,No.0,Month 2023,pp 1-13D0110.1002/art42507RHEUMATOLOGY2023 American College of RheumatologyEmpowering Rheumatology Profesionais2022 American College of Rheumatology Guideline forExercise,Rehabilitation,Diet,and Additional IntegrativeInterventions for Rheumatoid ArthritisBryant R.England,Benjamin J.Smith,2*NancyA.Baker,Jennifer L.Barton,Carol A.Oatis,Gordon Guyatt,s Allen Anandarajah,7Kristine CarandangKarmela Kim Chan,Deb Constien,10Eileen Davidson,1 Carole V.Dodge,12 Anita Bemis-Dougherty,Sotiria Everett,4Nadine Fisher,15Liana Fraenkel,16Susan M.Goodman,Janet Lewis,17 Victoria Menzies,Larry W.Moreland,1Iris Navarro-Millan,20Sarah Patterson,21Lawrence"Rick"Phillips,22 Neha Shah,23 Namrata Singh,24Daniel White,25Rawan AIHeresh,26Kamil E.Barbour,27Thomas Bye,25 Dana Guglielmo,28Rebecca Haberman,29Tate Johnson,Anatole Kleiner,7 Chris Y.Lane,30Linda C.Li,31Hiral Master,32Daniel Pinto,33 Janet L.Poole,34 Kimberly Steinbarger,Daniel Sztubinski,36 Louise Thoma,30Vlad Tsaltskan,37Marat Turgunbaev,38 Courtney Wells,39Amy S.Tumer,3and Jonathan R.Treadwell36Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR)areintended to provide guidance for patterns of practice and not to dictate the care of a particular patient.The ACR con-siders adherence to the recommendations within this guideline to be voluntary,with the ultimate determination regardingtheir application to be made by the clinician in light of each patient's individual circumstances.Guidelines and recom-mendations are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome.Guidelines and recommendations developed and endorsed by the ACR are subject to perodic revision as warrantedby the evolution of medical knowledge,technology,and practice.ACR recommendations are not intended to dictatepayment or insurance decisions,and drug formularies or other third-party analyses that cite ACR guidelines should statethis.These recommendations cannot adequately convey all uncertainties and nuances of patient care.The American College of Rheumatology is an independent,professional medical,and scientific society that does notguarantee,warrant,or endorse any commercial product or service.Objective.To develop initial American College of Rheumatology (ACR)guidelines on the use of exercise,rehabilitation,diet,and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs)as part of an integrative management approach for people with rheumatoid arthritis (RA).Methods.An interprofessional guideline development group constructed clinically relevant Population,Intervention,Comparator,and Outcome(PICO)questions.A literature review team then completed a systematic literature review andapplied the Grading of Recommendations Assessment,Development and Evaluation(GRADE)approach to rate the cer-tainty of evidence.An interprofessional Voting Panel (n=2
