AUTHOR=Lin Joshua , Liu Jing , O’Fee Allana , Pandey Chhiti , Benna-Doyle Sarah , Maunder Alison , Rao Vibhuti , Alesi Simon , Ng Beverly , Ee Carolyn 

TITLE=The effectiveness and safety of lifestyle medicine and integrative therapies in inflammatory arthritis: an umbrella review using a hierarchical evidence gathering approach

JOURNAL=Frontiers in Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1357914

DOI=10.3389/fmed.2024.1357914

ISSN=2296-858X

ABSTRACT=Objective: An umbrella review was conducted to provide a comprehensive evaluation of the evidence on lifestyle medicine and integrative therapies for inflammatory arthritis.Methods: Five electronic databases were searched for umbrella reviews, meta-analyses, and systematic reviews of randomised controlled trials on acupuncture, diet, exercise, herbal medicine, nutrient supplements, and mind-body therapies for rheumatoid arthritis, spondyloarthritis and gout published from January 2012-December 2022. Primary outcomes were functional status and quality of life. Quality assessment was performed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) tool, and certainty of evidence for our primary outcomes using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach where possible.Results: We included 52 reviews. Exercise was beneficial for functional status in both rheumatoid arthritis and spondyloarthritis with moderate certainty of evidence. Chinese herbal medicine in combination with disease-modifying antirheumatic drugs may improve functional status in rheumatoid arthritis (very low certainty evidence). Acupuncture may improve functional status in rheumatoid arthritis and pain in both rheumatoid arthritis and gout however the evidence is of very low certainty. Evidence for other therapies was not clinically significant however, suggests possible benefits from quercetin and polyunsaturated fatty acids. Yoga may result in a moderate effect size improvement in functional status when used as an adjunct to medication however, the certainty of evidence was very low. Diet interventions offered inconsistent improvements to functional status in rheumatoid arthritis, spondyloarthritis, and gout with low to very low certainty.  Conclusion: Exercise should be prescribed for people with rheumatoid arthritis and spondyloarthritis. Evidence for Chinese herbal medicine, acupuncture, yoga, and anti-inflammatory diets is promising however, future high-quality research is required to make more convincing recommendations.