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 and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations

Results. The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions.

Conclusion. This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team-based approach to RAmanagement. The conditional nature ofmost recommendations requires clinicians to engage persons with RA in shared decision-making when applying these recommendations.

目的：制定关于运动、康复、饮食和与改善病情抗风湿药物 (DMARD) 联合使用的额外干预措施的初始美国风湿病学会 (ACR) 指南，作为类风湿性关节炎 (RA) 患者综合管理方法的一部分。

方法：跨专业指南制定小组构建了临床相关人群、干预、对照和结局 (PICO) 问题。然后，文献综述团队完成了系统性文献综述，并应用建议评估、开发和评价分级 (GRADE) 方法对证据的确定性进行评级。由3名 RA 患者组成的跨专业投票小组（n = 20名参与者）就建议

结果：就方向（支持或反对）和强度（强烈或条件性）达成了共识。投票小组就使用综合干预联合 DMARD 治疗 RA 的28项建议达成了共识。持续参与运动得到了强有力的建议。在27项有条件的建议中，4项与运动有关，13项与康复有关，3项与饮食有关，7项与额外的综合干预有关。这些建议针对 RA 管理，认识到许多干预措施可能存在其他医学适应症和一般健康获益。

结论：本指南提供了 ACR 关于 RA 管理的综合干预伴随 DMARD 治疗的初始建议。这些建议中包括的广泛干预措施说明了跨专业、基于团队的 RAmanagement 方法的重要性。大多数建议的条件性要求临床医生在应用这些建议时让 RA 患者参与共同决策。