{"id":1037,"date":"2022-05-09T12:43:34","date_gmt":"2022-05-09T12:43:34","guid":{"rendered":"https:\/\/blogs.bmj.com\/rheumsummaries\/?p=1037"},"modified":"2022-05-26T11:49:37","modified_gmt":"2022-05-26T11:49:37","slug":"new-2021-eular-recommendations-for-lifestyle-and-work-in-people-with-rmds","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/rheumsummaries\/2022\/05\/09\/new-2021-eular-recommendations-for-lifestyle-and-work-in-people-with-rmds\/","title":{"rendered":"New: 2021 EULAR Recommendations for lifestyle and work in people with RMDs"},"content":{"rendered":"<p>This is the lay version of the 2021 EULAR recommendations for lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases. The original publication can be downloaded from the EULAR website: <a href=\"http:\/\/www.eular.org\">www.eular.org<\/a>.<\/p>\n<p>Gwinnutt JM, et al. 2021 EULAR recommendations regarding lifestyle behaviours and work participation to<br \/>\nprevent progression of rheumatic and musculoskeletal diseases. Annals of the Rheumatic Diseases<br \/>\nPublished Online First: 08 March 2022. doi: 10.1136\/annrheumdis-2021-222020<\/p>\n<p><strong>Introduction<\/strong><br \/>\nEULAR provides advice to health professionals and patients about the best way to treat and manage<br \/>\nrheumatic and musculoskeletal diseases (RMDs). Doctors, other health professionals, and patients, worked together to develop these recommendations on lifestyle and work in people with RMDs. Patients in the team ensured that patients\u2019 points of view were included.<\/p>\n<p><strong>What do we already know?<\/strong><br \/>\nRMDs affect a lot of people, causing disability and reducing quality of life. There are pharmacological<br \/>\ntreatments for some RMDs such as rheumatoid arthritis and gout. These treatments can reduce disease<br \/>\nactivity and prevent disability, but for many people there is still room for improvement. Furthermore, some RMDs such as osteoarthritis do not have effective pharmacological treatment options. People, therefore, often look for ways to make lifestyle changes that might further help ease the symptoms or severity of their RMD.<\/p>\n<p>All adults should aim for a healthy, balanced diet containing fruits, vegetables, nuts, and whole grains \u2013 and with limited amounts of sugar, fat, and salt. We also know that physical activity is fundamental to good health, and that obesity, smoking, and drinking too much alcohol can have negative health consequences. These are clear messages for the general population, but for people with RMDs these aspects of health have not yet been prioritized in strategies to promote musculoskeletal health.<\/p>\n<p>EULAR set up a taskforce to look at the evidence regarding lifestyle and behaviour modification in seven common inflammatory and non-inflammatory RMDs: osteoarthritis, rheumatoid arthritis, axial<br \/>\nspondyloarthritis, psoriatic arthritis, systemic lupus erythematosus, systemic sclerosis, and gout.<\/p>\n<p><strong>What do the recommendations say?<\/strong><br \/>\nIn total, there are five overarching principles and 18 recommendations across six key categories of exercise, diet, weight, alcohol, smoking, and work participation. The principles define the importance of a healthy lifestyle, how lifestyle modifications should be implemented, and their role in relation to medical treatments.<\/p>\n<p>Each recommendation is based on the best current knowledge from scientific studies and\/or expert opinion. The more stars a recommendation has, the stronger the evidence is. However, recommendations with limited scientific evidence may still be important, because experts can have a strong opinion even when published evidence may be lacking.<\/p>\n<p>One star (*) means it is a recommendation with limited scientific evidence.<br \/>\nTwo stars (**) means it is a recommendation with some scientific evidence.<br \/>\nThree stars (***) means it is a recommendation with quite a lot of scientific evidence.<br \/>\nFour stars (****) means it is a recommendation supported with a lot of scientific evidence.<\/p>\n<p><em>Exercise<\/em><\/p>\n<ul>\n<li><strong>Exercise is good for health outcomes, and may help reduce your RMD symptoms and<br \/>\nprogression.*<\/strong><br \/>\nExercise can help improve a lot of general health outcomes. If you have an RMD, your health team<br \/>\nshould work with you to find a type of activity that is appropriate for your ability and condition.<\/li>\n<li><strong>People with RMDs should exercise because of the benefits on pain, function, and<br \/>\nquality of life.****<\/strong><br \/>\nThe benefits of exercise have been shown for RMD-specific outcomes, such as pain and disability. In<br \/>\ngeneral, appropriate exercise can help improve pain, function, fatigue, and health-related quality of life in people with RMDs. The evidence is stronger for short-term benefits over 6\u201312 months compared with long-term benefits, although long-term benefits have been shown for the general population across a range of health outcomes.<\/li>\n<li><strong>If you have an RMD, you should avoid physical inactivity; take regular exercise according to your abilities.*<\/strong><br \/>\nSedentary behaviour is associated with many negative health outcomes in the general population.<br \/>\nThese negative outcomes will also affect people with RMDs. If you have an RMD, your health care team should encourage you to avoid prolonged periods of physical inactivity.<\/li>\n<li><strong>People with RMDs should perform both aerobic and strengthening exercises \u2013 aim for at least moderate intensity.****<\/strong><br \/>\nThere is evidence to suggest that both aerobic and strengthening exercises are beneficial for people<br \/>\nwith RMDs, so you should include both when exercising. Aerobic exercise is also called \u201ccardio\u201d \u2013<br \/>\nactivities that increase your breathing and heart rate. People with RMDs should aim for moderate<br \/>\nintensity aerobic exercise (64\u201376% of your maximal heart rate) for at least 150 minutes every week, and strengthening exercises such as weights or resistance training twice a week.<\/li>\n<li><strong>People with RMDs should be advised that exercise is safe and that it is never too late to start.****<\/strong><br \/>\nVery few people have adverse events related to exercise. If you have an RMD, exercise is a safe way to improve your health condition, and it is never too late to take up exercise \u2013 even if you were not very physically active before your RMD started.<\/li>\n<li><strong>Exercise can be performed in different settings, alone or in groups.****<\/strong><br \/>\nThere are a lot of different exercise types, and you should choose the one that suits you best. There is some evidence that group exercise might be slightly better than exercising on your own, and you might benefit from the supervision and social aspect of a class \u2013 but if you prefer to work on your own this should not discourage you.<\/li>\n<li><strong>If you have osteoarthritis or axial spondyloarthritis, exercise is particularly beneficial.****<\/strong><br \/>\nStudies in people with osteoarthritis or axial spondyloarthritis showed that exercise can have a strong and consistent effect on reducing pain and improving function.<\/li>\n<li><strong>Consuming more or less of specific food types is unlikely to have large benefits for RMD <\/strong><strong>outcomes.****<\/strong><br \/>\nSome small studies have suggested that certain food components should be increased or avoided in people with certain RMDs. However, the evidence is very limited, and at present EULAR believe it is unlikely that eating specific food types will have large effects on RMD-specific outcomes. The only exception is that people with gout may benefit from avoiding sugar-sweetened drinks, heavy meals, and excessive amounts of meat and seafood.<\/li>\n<\/ul>\n<p><em>Weight<\/em><\/p>\n<ul>\n<li><strong>People with RMDs should aim for a healthy weight.*<\/strong><br \/>\nIn adults, a body mass index (BMI) of 25 or more is considered overweight, and 30 or more is classed<br \/>\nas obese. However, what is a \u201chealthy weight\u201d varies from person to person. Your goal should be based on your age and sex, as well as your underlying disease and health state. If you lose or gain weight, this can have an effect on some medications, so you should talk to the health professionals involved in your care if you are concerned about your weight.<\/li>\n<li><strong>If you are overweight or obese, work with your health professionals to achieve controlled and<\/strong><br \/>\n<strong>intentional weight loss through healthy diet and increased physical activity.***<\/strong><br \/>\nIf you have a BMI of 25 or more, achieving controlled weight loss could be beneficial for some RMD<br \/>\noutcomes. Talk to the health professionals involved in your care to learn about achieving healthy weight loss through diet and exercise.<\/li>\n<\/ul>\n<p>Alcohol<\/p>\n<ul>\n<li><strong>Your health team may want to discuss alcohol consumption with you, particularly if you are<\/strong><br \/>\n<strong>starting a new treatment.*<\/strong><br \/>\nThere are negative health consequences of drinking too much alcohol. Health professionals may raise this with you to ensure you know what the healthy limits are \u2013 as well as to ensure you know if you cannot drink on a particular medication.<\/li>\n<li><strong>If you have an RMD, a low level of alcohol consumption is unlikely to negatively impact your<\/strong><br \/>\n<strong>RMD outcomes, except in certain situations.***<\/strong><br \/>\nIn general, alcohol is fine in moderation. The exception would be if you have liver disease, or if you are prescribed certain medications \u2013 for example, methotrexate or leflunomide.<\/li>\n<li><strong>Health professionals and people with rheumatoid arthritis should be aware that moderate<\/strong><br \/>\n<strong>alcohol consumption is associated with increased risk of flare and comorbidities.***<\/strong><br \/>\nIf you have rheumatoid arthritis, even moderate alcohol consumption can increase your risk of having a disease flare or developing other linked diseases (comorbidities). Your health care team may raise this with you to ensure you know what the healthy limits are for you \u2013 as well as to ensure you know if you cannot drink on a particular medication.<\/li>\n<li><strong>Health professionals and people with gout should be aware that moderate alcohol consumption <\/strong><strong>is associated with increased risk of gout flare.***<\/strong><br \/>\nIf you have gout, any alcohol consumption can increase your risk of having a flare. Your health care<br \/>\nteam may raise this with you to ensure you know the risks.<\/li>\n<\/ul>\n<p>Smoking<\/p>\n<ul>\n<li><strong>People with RMDs should be encouraged to stop smoking and be informed that smoking is<\/strong><br \/>\n<strong>detrimental to symptoms, function, disease activity, disease progression and occurrence of<\/strong><br \/>\n<strong>comorbidities in all RMDs.***<\/strong><br \/>\nIt is well known that smoking is bad for you. In addition to the risks for people in the general population, if you have an RMD smoking can also have a negative impact on your disease, and may worsen your symptoms. If you are interested in quitting, you should talk to your health professional to see what support and resources might be available to you.<\/li>\n<li><strong>Smoking may affect how well your RMD medicines work.***<\/strong><br \/>\nThe response to some RMD medications can be less in people who smoke. If you are interested in<br \/>\nquitting, you should talk to your health professional to see what support and resources might be<br \/>\navailable to you.<\/li>\n<\/ul>\n<p>Work<\/p>\n<ul>\n<li><strong>Work participation may be beneficial for people with RMDs; this should be addressed in health<\/strong><br \/>\n<strong>care consultations.***<\/strong><br \/>\nIf you are able to stay in work, you may find it has a positive effect, particularly on your mental health.<br \/>\nWhat type of work you are able to do will depend on your individual circumstances, and some people<br \/>\nmay find that physically demanding jobs worsen their RMD symptoms. Advice and support around your work participation should be given by your health care team.<\/li>\n<\/ul>\n<p><strong>Summary<\/strong><br \/>\nOverall, these recommendations cover a range of important, modifiable lifestyle behaviours. In general, the World Health Organization recommendations for a healthy lifestyle are also applicable to people with RMDs, although recommendations for each individual with an RMD depend on factors such as age, gender, health condition, pregnancy and possible other linked health conditions. EULAR hopes these new<br \/>\nrecommendations will be used to guide shared decision-making between people with RMDs and health<br \/>\nprofessionals when formulating and monitoring treatment plans. There should be regular discussions<br \/>\nbetween people with RMDs and health professionals regarding lifestyle behaviours and work participation..<\/p>\n<p>If you have any questions or concerns about your disease or your medication, you should speak to a health professional involved in your care.<\/p>\n<p><strong>Disclaimer:<\/strong> This is a summary of a scientific article written by a medical professional (\u201cthe Original Article\u201d). The Summary is written to assist non medically trained readers to understand general points of the Original Article. It is supplied \u201cas is\u201d without any warranty. You should note that the Original Article (and Summary) may not be fully relevant nor accurate as medical science is constantly changing and errors can occur. It is therefore very important that readers not rely on the content in the Summary and consult their medical professionals for all aspects of their health care and only rely on the Summary if directed to do so by their medical professional. Please view our full <a href=\"https:\/\/www.bmj.com\/company\/legal-information\/\">Website Terms and Conditions<\/a>.<\/p>\n<p><strong>Copyright<\/strong> \u00a9 2022 BMJ Publishing Group Ltd &amp; European League Against Rheumatism. Medical professionals may print copies for their and their patients and students non commercial use. Other individuals may print a single copy for their personal, non commercial use. For other uses please contact our <a href=\"https:\/\/www.bmj.com\/company\/products-services\/rights-and-licensing\/\">Rights and Licensing Team<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>This is the lay version of the 2021 EULAR recommendations for lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases. The original publication can be downloaded from the EULAR website: www.eular.org. Gwinnutt JM, et al. 2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/rheumsummaries\/2022\/05\/09\/new-2021-eular-recommendations-for-lifestyle-and-work-in-people-with-rmds\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":436,"featured_media":1044,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[45],"class_list":["post-1037","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-eular-recommendations","tag-featured"],"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/posts\/1037","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/users\/436"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/comments?post=1037"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/posts\/1037\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/media\/1044"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/media?parent=1037"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/categories?post=1037"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/tags?post=1037"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}