Although the management of rheumatoid arthritis (RA) has improved remarkably with
new pharmacological therapies, there is still a significant part of patients not reaching
treatment goals. Difficult-to-treat RA (D2TRA) is a complex entity involving several
factors apart from persistent inflammation, thereafter requiring a holistic management
approach. As pharmacological treatment options are often limited in D2TRA, the need
for non-pharmacological treatments (NPT) is even more pronounced. The mechanism of
action of non-pharmacological treatments is not well investigated, NPTs seem to have
a complex, holistic effect including the immune, neural and endocrine system, which
can have a significant additive benefit together with targeted pharmacotherapies in
the treatment of D2TRA. In this review we summarize the current knowledge on different
NPT in rheumatoid arthritis, and we propose a NPT plan to follow when managing D2TRA
patients.
