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Integrative non-pharmacological care for individuals at risk of rheumatoid arthritis

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Abstract

There is increasing knowledge in the recognition of individuals at risk for progression to rheumatoid arthritis (RA) before the clinical manifestation of the disease. This prodromal phase preceding the manifestation of RA may represent a “window of opportunity” for preventive interventions that may transform the clinical approach to this disease. However, limited evidence exists in support of effective interventions to delay the onset or even halt the manifestation of RA. Given the multifactorial nature of RA development and disease progression, the latest guidelines for established RA stress the use of integrative interventions and multidisciplinary care strategies, combining pharmacologic treatment with non-pharmacological approaches. Accordingly, individuals at risk of RA could be offered an integrative, multifactorial intervention approach. Current data point toward pharmacological intervention reverting the subclinical inflammation and delay in the disease onset. In addition, targeting life style modifiable factors (smoking cessation, dental health, physical activity, and diet) may presumably improve RA prognosis in individuals at risk, mainly by changes in epigenetics, autoantibodies, cytokines profiles, and microbiome. Nonetheless, the benefits of multidisciplinary interventions to halt the manifestation of RA in at-risk individuals remain unknown. As there is a growing knowledge of possible pharmacological intervention in the preclinical phase, this narrative review aims to provide a comprehensive overview of non-pharmacological treatments in individuals at risk of RA. Considering the mechanisms preceding the clinical manifestation of RA we explored all aspects that would be worth modifying and that would represent an integrative non-pharmacological care for individuals at risk of RA.

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TV is supported by the Cooperatio Program, research area Sport Sciences—Biomedical & Rehabilitation Medicine, NR, MT, and MF by the Ministry of Health Czech Republic (023728 and NU22-05–00226), and for NR by SVV260523. CM is funded by Nicolás Monardes Programe from Consejerı́a de Salud de la Junta de Andalucı́a (C2-0002–2019). KDM. has participated in the Exchange Programme for Scientists as part of bilateral cooperation financed by The Polish National Agency for Academic Exchange (NAWA: BPN/BIL/2021/1/00108/U/DRAFT/00001). JCI is supported by the University of Murcia (“Moving Minds” research mobility grant) and the Spanish Ministry of Science and Innovation Grant No. PID2019-108202RA-I00.

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Authors and Affiliations

  1. Department of Physical Education and Sport, University of Granada, C/Camino de Alfacar, 21, 18071, Granada, Spain

    Javier Courel-Ibáñez

  2. Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic

    Tomas Vetrovsky & Krzysztof Durkalec-Michalski

  3. Department of Rheumatology, 1st Faculty of Medicine, Institute of Rheumatology, Charles University, Prague, Czech Republic

    Nora Růžičková, Michal Tomcik & Mária Filková

  4. Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research (GENYO), Granada, Spain

    Concepción Marañón

  5. Department of Sports Dietetics, Poznan University of Physical Education, Poznan, Poland

    Krzysztof Durkalec-Michalski

Authors
  1. Javier Courel-Ibáñez
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  2. Tomas Vetrovsky
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  3. Nora Růžičková
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  4. Concepción Marañón
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  5. Krzysztof Durkalec-Michalski
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  6. Michal Tomcik
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  7. Mária Filková
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Contributions

JC, MT, and MF conceptualized, designed the study, and drafted the manuscript. TV, NR, CM, and KDM drafted specific sections of the manuscript and critically reviewed the final draft for important intellectual content. All authors approved the final version of the manuscript. All authors take full responsibility for the integrity and accuracy of all aspects of the work. No AI or other software was used for writing or editing this review.

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Correspondence to Javier Courel-Ibáñez.

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Courel-Ibáñez, J., Vetrovsky, T., Růžičková, N. et al. Integrative non-pharmacological care for individuals at risk of rheumatoid arthritis. Rheumatol Int 44, 413–423 (2024). https://doi.org/10.1007/s00296-023-05507-y

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