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2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases
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  1. James M Gwinnutt1,
  2. Maud Wieczorek2,
  3. Andra Balanescu3,
  4. Heike A Bischoff-Ferrari4,5,6,
  5. Annelies Boonen7,8,
  6. Giulio Cavalli9,
  7. Savia de Souza10,
  8. Annette de Thurah11,12,
  9. Thomas E Dorner13,14,15,
  10. Rikke Helene Moe16,
  11. Polina Putrik7,8,
  12. Javier Rodríguez-Carrio17,18,
  13. Lucía Silva-Fernández19,
  14. Tanja Stamm20,21,
  15. Karen Walker-Bone22,
  16. Joep Welling23,
  17. Mirjana I Zlatković-Švenda24,25,
  18. Francis Guillemin2,26,
  19. Suzanne M M Verstappen1,22,27
  1. 1 Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
  2. 2 EA 4360 Apemac, Université de Lorraine, Nancy, France
  3. 3 Department of Internal Medicine and Rheumatology, “Sf. Maria” Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  4. 4 Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
  5. 5 Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
  6. 6 University Clinic for Aging Medicine, City Hospital Zurich - Waid, Zurich, Switzerland
  7. 7 Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
  8. 8 Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
  9. 9 Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
  10. 10 Centre for Rheumatic Diseases, King's College London, London, UK
  11. 11 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  12. 12 Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
  13. 13 Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria
  14. 14 Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria
  15. 15 Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
  16. 16 National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
  17. 17 Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain
  18. 18 Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
  19. 19 Rheumatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
  20. 20 Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
  21. 21 Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
  22. 22 MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
  23. 23 NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
  24. 24 Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia
  25. 25 Department of Internal Medicine, University of East Sarajevo Faculty of Medicine Foča, Republika Srpska, Bosnia and Herzegovina
  26. 26 Inserm, CHRU Nancy, CIC-1433 Epidémiologie Clinique, Université de Lorraine, Nancy, France
  27. 27 NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
  1. Correspondence to Dr Suzanne M M Verstappen, Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PT, UK; Suzanne.Verstappen{at}manchester.ac.uk

Abstract

Objectives A European League Against Rheumatism taskforce was convened to review the literature and develop recommendations on lifestyle behaviours for rheumatic and musculoskeletal diseases (RMDs).

Methods Six lifestyle exposures (exercise, diet, weight, alcohol, smoking, work participation) and seven RMDs (osteoarthritis, rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, systemic lupus erythematosus, systemic sclerosis, gout) were considered. The taskforce included health professionals in rheumatology, geriatricians, epidemiologists, public health experts, people with RMDs and exposure domain experts. Systematic reviews were conducted to gather available evidence, from which recommendations were developed.

Results Five overarching principles and 18 specific recommendations were defined based on available evidence. The overarching principles define the importance of a healthy lifestyle, how lifestyle modifications should be implemented, and their role in relation to medical treatments. Exercise recommendations highlight the safety and benefits of exercise on pain and disability, particularly among people with osteoarthritis and axial spondyloarthritis. The diet recommendations emphasise the importance of a healthy, balanced diet for people with RMDs. People with RMDs and health professionals should work together to achieve and maintain a healthy weight. Small amounts of alcohol are unlikely to negatively affect the outcomes of people with RMDs, although people with rheumatoid arthritis and gout may be at risk of flares after moderate alcohol consumption. Smokers should be supported to quit. Work participation may have benefits on RMD outcomes and should be discussed in consultations.

Conclusions These recommendations cover a range of lifestyle behaviours and can guide shared decision making between people with RMDs and health professionals when developing and monitoring treatment plans.

  • smoking
  • patient reported outcome measures
  • arthritis
  • epidemiology

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Footnotes

  • Handling editor Josef S Smolen

  • Twitter @james_gwinnutt, @MoeRikke

  • Contributors JMG, MW, FG and SMMV contributed equally. SMMV conceived the idea and submitted the project with a contribution from FG to the EULAR executive committee. JMG and MW were the research fellows on the project who carried out the systematic literature reviews, with the help of PP, Maxime Ransay and EMEUNET members GC and JRC. These reviews were overseen by FG (methodologist) and SMMV (convenor). SMMV organised and chaired the telephone and face-to-face meetings. All authors contributed to the drafting of recommendations at the telephone and face-to-face meetings and helped to revise the recommendations manuscript.

  • Funding SMMV and JMG are supported by Versus Arthritis (21755) and the NIHR Manchester Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. JRC is supported by the Juan de la Cierva (IJCI-2017-32070) and Sara Borrell (CD19/00120) programs. The taskforce would like to thank EULAR for providing financial support for this project.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.