3 Things I Learned at the Latest American College of Rheumatology Conference

Research leads to greater medical care and treatments. Here are some of the latest findings on lifestyle management, brain fog, and oral health for your RA.

Every year, rheumatologists, researchers, and other health professionals explore the latest research at the American College of Rheumatology’s (ACR) Convergence conference.

As an occupational therapist who’s lived with rheumatoid arthritis (RA) for two decades, I always look forward to learning what’s new in the rheumatology field.

Rheumatology aims to understand systemic autoimmune diseases that may cause inflammation in the joints, tendons, ligaments, bones, and muscles, such as RA.

I attended the latest conference in Philadelphia, Pennsylvania, at the end of 2022. I was so excited to see a strong dedication to finding the best evidence for improving quality of life and reducing disease activity.

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Not all lifestyle interventions are equally effective for RA

I’m always interested in ways that I can manage my condition beyond medications. But the options can be overwhelming — from nutrition and exercise to mindfulness and mind-body approaches.

Our energy, time, and money are limited, so I’m always on the lookout for resources to help me get the biggest “bang for my buck.”

I attended a panel that discussed the 2022 ACR Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis.

These guidelines review which lifestyle and integrative interventions are most effective for improving physical function, decreasing pain, and overall disease activity of RA.

A topic of great interest for a lot of patients is knowing which dietary and nutritional interventions have the best evidence for improving symptoms of RA. The Mediterranean-style diet was the overall winner. The panel recommended against any other defined diet other than a Mediterranean-style one. They also suggested avoiding dietary supplements.

The guidelines recommend trying other traditional therapies including physical therapy, occupational therapy, and self-management strategies. But based on current evidence, the panel recommended against any chiropractic therapy and electrotherapy.

Out of all lifestyle interventions, consistently engaging in exercises had the strongest evidence for improving physical function and decreasing RA pain.

Exercise was more effective than any other lifestyle intervention, including nutrition, rehabilitation approaches, acupuncture, and more. Specifically, aerobic, aquatic, resistance, and mind-body exercises (such as yoga) were recommended.

But regardless of the type of exercise, consistently engaging in whatever exercise works for you was strongly recommended.

So, if you are feeling overwhelmed by lifestyle management options, exercise is the place to start. Exercise can feel foreign to some people, but remember that exercise comes in all forms. This might be a daily walk with some friends or even some sofa yoga.

These latest lifestyle guidelines focus on pain and physical functioning as important outcomes. I hope that future guidelines will also prioritize research on reducing fatigue and improving psychological well-being.

Brain fog is real — RA can affect cognitive performance

Like many who live with RA, I sometimes experience brain fog. This includes difficulty with memory, attention, word retrieval, and mental fatigue.

Over the last two decades of living with RA, I have rarely known researchers or health professionals to even ask about it, much less actively address it.

So, I was excited to see that there was a panel about RA disease activity and cognitive dysfunction.

After looking at a data registry of over 33,000 adults with RA, the researchers discovered that 9.1% reported cognitive difficulties. The people more likely to report these difficulties were experiencing increasing disease activity, and — surprisingly — were younger.

As with much cutting-edge research, the conclusion was that more research is needed. For now, I take comfort in the fact that there is at least a plausible explanation behind brain fog — it’s not “just in your head.”

I hope that researchers will prioritize finding ways to improve brain fog and cognitive functioning. For example, research from 2020 showed that people with RA who exercised had improved cognitive performance.

Gum disease can reduce the effectiveness of RA medications

Why do some people with RA do well on standard treatments while others don’t?

Those that don’t respond to medications are often referred to as having treatment-resistant RA or difficult-to-treat RA. This is RA that doesn’t respond to the traditional disease-modifying antirheumatic drugs (DMARDs), like methotrexate, or biologic-DMARDS.

The field of personalized medicine seeks to explore why some respond to treatments while others don’t. The ultimate goal is to tailor treatments to the patient’s unique characteristics, including the genome and microbiome.

One of the talks I attended explored the relationship between treatment-resistant RA and gum disease.

Patients with RA are more likely to have gum disease. And those with RA and gum disease are much more likely to have treatment-resistant RA.

For example, RA patients with gum disease who started a TNF-inhibitor medication were less likely to have a positive response to the medication than those without gum disease.

The take-home message: Do not neglect your oral health if you have RA, particularly your gum health!

Conclusions

I really enjoy learning about the latest research in rheumatology.

Some of the panels left me with more questions than answers. For example, I learned that fibromyalgia is much more prevalent within the population of people who have rheumatic diseases.

Fibromyalgia occurs in roughly 2–4% of the population but is estimated to increase to 18–24% of people with RA, 18% of people with psoriatic arthritis (PsA), and 14–16% of people with axial spondyloarthritis. I learned about some of the latest findings in fibromyalgia research, but there are still so many unknowns.

Still, these conferences give me hope about the future of research and what it means for those of us living with rheumatic diseases like RA.

My biggest takeaways for my own life with RA are:

• continue to exercise on a consistent schedule
• integrate more Mediterranean recipes into my diet
• recognize that my brain fog is real, and explore whether exercise could help it
• prioritize my oral health and do everything in my power to avoid gum disease

I’m already looking forward to next year’s conference which I hope will provide even more exciting research.