Lifestyle Medicine and Rheumatoid Arthritis in Viet Nam: Physical Activity, Persistent Pain, and Disease-Modifying Therapy

Lifestyle Medicine and Rheumatoid Arthritis in Viet Nam: Physical Activity, Persistent Pain, and Disease-Modifying Therapy

Primary category: Evidence & Clinical Practice

Secondary category: Lifestyle Medicine in Viet Nam

Article type: VLMA Perspective

Last reviewed: October 30, 2026

At a follow-up appointment, a person with rheumatoid arthritis reports that the swelling in their hands has improved since starting treatment. Their blood tests also suggest that inflammation is better controlled. Yet they continue to experience widespread pain, poor sleep, and exhaustion. Some mornings, getting dressed or preparing breakfast still takes considerable effort.

Does this mean the rheumatoid arthritis treatment is not working? Should the medication be increased, or could something else be contributing to the symptoms?

These questions matter because rheumatoid arthritis involves more than joint pain. It is a chronic systemic autoimmune disease that can damage joints and affect other organs. Even when inflammation is better controlled, pain, fatigue, and functional limitations may persist for several reasons.

Evidence-based Lifestyle Medicine can contribute through appropriate physical activity, nutrition, sleep support, smoking cessation, and interventions that help people maintain function while living with a chronic condition. However, these approaches cannot replace disease-modifying treatment or remove the need to assess continuing inflammation.

For healthcare professionals in Viet Nam, the challenge is to recognize which problems are related to active rheumatoid arthritis, which may have other explanations, and how each should be addressed. Not every symptom requires more immunosuppressive medication, but healthier living alone cannot be relied upon to control the underlying autoimmune disease.

Rheumatoid Arthritis Requires More Than Symptom Relief

Rheumatoid arthritis is a systemic autoimmune disease characterized by persistent inflammation, particularly involving the synovial lining of joints.

It commonly affects the small joints of the hands and feet, often causing pain, swelling, and prolonged morning stiffness. The pattern varies between individuals, however, and larger joints may also be involved.

Without effective treatment, continuing inflammation can damage cartilage and bone, cause deformity, and reduce physical function.

Rheumatoid arthritis may also affect structures outside the joints, including the lungs, eyes, and cardiovascular system. These manifestations require appropriate clinical assessment and cannot be explained solely by physical activity or other lifestyle behaviors.

The condition differs from osteoarthritis, in which degenerative and inflammatory processes contribute to joint symptoms. It also differs from gout, where monosodium urate crystals trigger inflammatory attacks.

These distinctions are important because the treatments required to prevent disease progression are not interchangeable.

A person with rheumatoid arthritis may experience meaningful improvement in pain or physical function after beginning exercise or another supportive intervention. However, symptom improvement does not necessarily establish that inflammatory disease activity is adequately controlled.

The reverse is equally important. Persistent pain does not automatically mean that active inflammation remains the principal problem.

Rheumatoid arthritis should be considered when someone develops persistent inflammatory joint symptoms, particularly swelling involving several small joints and prolonged morning stiffness.

Clinical assessment may include examination for synovitis, evaluation of symptom patterns and duration, inflammatory markers, rheumatoid factor, anti-citrullinated protein antibodies, and appropriate imaging.

These findings must be interpreted together. Some patients with rheumatoid arthritis have negative autoantibody tests, while a positive rheumatoid factor result does not independently confirm the diagnosis.

Early recognition matters because delayed treatment can allow persistent inflammation and irreversible joint damage.

The clinical objective is therefore to suppress the underlying inflammatory disease, prevent structural damage, and address other factors affecting the person's health and daily functioning.

The 2026 EULAR Recommendations Reinforce Early Disease-Modifying Treatment

On March 12, 2026, the European Alliance of Associations for Rheumatology (EULAR) published updated recommendations for managing rheumatoid arthritis with disease-modifying antirheumatic drugs. Although described as the 2025 update, the recommendations were published online in 2026 and subsequently appeared in the June issue of Annals of the Rheumatic Diseases. [1]

The updated document contains five overarching principles and nine treatment recommendations.

Its approach remains centered on early initiation of disease-modifying treatment, shared decision-making, regular assessment of disease activity, and adjustment of therapy when treatment goals are not achieved.

The objective is sustained remission or low disease activity, according to the patient's clinical circumstances.

For patients with active rheumatoid arthritis, EULAR recommends frequent monitoring, generally every one to three months. If there is no improvement within approximately three months after treatment begins, or the treatment target has not been achieved by six months, the therapeutic strategy should be adjusted.

Methotrexate remains a preferred component of the initial treatment strategy for many patients when appropriate and not contraindicated. Other conventional synthetic disease-modifying medicines, including leflunomide or sulfasalazine, may be considered when methotrexate cannot be used.

The recommendations also recognize a role for short-term glucocorticoids when initiating or changing conventional synthetic treatment, with the intention of reducing and discontinuing them as rapidly as clinically feasible.

When the treatment target is not achieved, additional disease-modifying treatment may be needed. Biological medicines can be introduced according to clinical circumstances, while targeted synthetic therapies, including Janus kinase inhibitors, require careful consideration of relevant safety risks.

For patients who achieve sustained remission after discontinuing glucocorticoids, reduction of disease-modifying treatment doses may be considered under appropriate clinical supervision. However, complete discontinuation frequently leads to disease recurrence.

These recommendations establish an important boundary for Lifestyle Medicine.

Healthy behaviors may support physical function, cardiovascular health, and quality of life, but they do not provide a reliable substitute for treatments demonstrated to suppress rheumatoid arthritis activity and prevent progressive joint damage.

A successful exercise or nutrition program should not, by itself, become a reason to withdraw effective disease-modifying medication.

Physical Activity Should Be Part of Routine Care

People living with rheumatoid arthritis may reduce physical activity because of joint pain, fatigue, stiffness, or fear that movement will damage their joints.

Some have experienced increased discomfort after exercising and may conclude that avoiding activity is safer.

However, prolonged inactivity can contribute to muscle weakness, declining cardiovascular fitness, reduced physical function, and increasing difficulty with everyday tasks.

Evidence supports regular, appropriately selected physical activity as part of rheumatoid arthritis care.

The American College of Rheumatology's guideline on exercise, rehabilitation, diet, and additional integrative interventions, published in 2023, strongly recommends consistent engagement in exercise rather than no exercise. The recommendation is supported by moderate-certainty evidence of improvements in physical function and pain. [2]

Importantly, the guideline does not prescribe one exercise type, intensity, or duration for every person with rheumatoid arthritis.

Aerobic training, resistance exercises, aquatic activities, and mind-body approaches may offer different benefits depending on the person's condition and goals.

A further international development occurred on April 26, 2026, when EULAR published updated recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. [3]

The 2025 update contains four overarching principles and eleven recommendations addressing physical activity and sedentary behavior.

The recommendations emphasize incorporating physical activity promotion into routine care, assessing individual needs, adapting interventions, and using appropriate behavioral strategies to support participation.

They also consider technology-supported approaches to behavior change, although their effectiveness and suitability depend on the intervention, population, and healthcare setting.

For people with rheumatoid arthritis, aerobic activity may improve cardiovascular fitness, while resistance training can support muscle strength and physical performance. Functional exercises may help preserve mobility and the ability to complete everyday tasks.

The appropriate combination depends on disease activity, joint condition, physical capacity, associated illnesses, preferences, and treatment goals.

Physical activity is not limited to structured exercise sessions. Walking, active transportation, household activities, and other forms of movement can contribute to general health.

The important message is not that people with rheumatoid arthritis should exercise regardless of symptoms. It is that appropriate movement should remain part of care, with adjustments when clinical circumstances change.

Exercise During a Flare Requires Clinical Judgment

An inflammatory flare can make ordinary movement difficult.

A person may experience increased joint swelling, stiffness, pain, and reduced ability to perform activities that were manageable only a few days earlier.

Continuing to increase exercise intensity without considering these changes may be inappropriate.

An active flare may require temporary modification of activities, reduced loading on affected joints, and reassessment of inflammatory disease treatment.

However, complete inactivity is not necessarily required for every flare.

Gentle movement, appropriate range-of-motion activities, and modifications to daily tasks may help preserve function when they can be performed safely.

The distinction is between movement suited to the current clinical condition and activities that place excessive stress on actively inflamed, unstable, or structurally damaged joints.

Someone with well-controlled rheumatoid arthritis and no significant joint damage may tolerate progressive strengthening. Another person with severe active synovitis, joint instability, or substantial deformity may require a different approach.

Some patients benefit from supervised rehabilitation, particularly when they have longstanding functional limitations, reduced confidence in movement, or difficulty identifying suitable activities.

Healthcare professionals should also distinguish temporary exercise-related discomfort from symptoms suggesting a new inflammatory problem, injury, or infection.

Persistent or increasing joint swelling, substantial loss of function, or a significant change in symptoms requires appropriate assessment.

A suddenly hot and markedly swollen joint, particularly when accompanied by fever or systemic illness, may indicate septic arthritis or another urgent condition. This possibility is especially important in people receiving immunosuppressive treatment.

Such findings should not automatically be interpreted as an ordinary rheumatoid arthritis flare.

The aim is to preserve appropriate movement without overlooking clinical problems that require medical attention.

Reducing Sedentary Time Is a Separate Consideration

The 2026 EULAR physical activity recommendations place greater emphasis on reducing sedentary behavior.

This distinction matters because someone may complete a short exercise session but spend most of the remaining day sitting or lying down.

For people living with rheumatoid arthritis, prolonged sedentary time may reflect pain, fatigue, functional limitations, work requirements, or fear of worsening symptoms.

Reducing inactivity may involve manageable changes such as brief movement breaks, changing positions more regularly, or incorporating suitable activity into everyday routines.

For some people, these adjustments may be more achievable than immediately beginning a demanding exercise program.

However, evidence concerning interventions specifically designed to reduce sedentary behavior in inflammatory arthritis remains limited.

The EULAR update recognizes the potential health benefits of reducing sedentary time while emphasizing the need for interventions adapted to individual capabilities and circumstances. [3]

Consequently, spending less time sitting should not be presented as proof of reduced rheumatoid arthritis disease activity.

A person who moves more frequently may improve general physical function or reduce prolonged inactivity without necessarily changing the underlying autoimmune process.

Interventions also need to reflect everyday life.

Someone working at a desk may benefit from short movement breaks. A person performing physically demanding work may instead need greater attention to recovery, fatigue management, and joint protection.

A practical approach should respond to the person's actual activity pattern rather than impose identical movement targets on everyone.

Persistent Pain Does Not Always Mean Persistent Inflammation

One of the most challenging situations in rheumatoid arthritis care occurs when joint swelling and inflammatory markers improve, but the patient continues to experience substantial pain.

Several mechanisms may contribute.

Previous structural joint damage can cause mechanical pain. Osteoarthritis, tendon disorders, neuropathic pain, and other musculoskeletal conditions may coexist with rheumatoid arthritis.

Persistent inflammatory synovitis may also remain despite apparently reassuring routine blood tests.

Another possibility is altered pain processing, including nociplastic pain or coexisting fibromyalgia.

Fibromyalgia is characterized by widespread pain, often accompanied by fatigue, sleep disturbance, and cognitive symptoms.

It can occur alongside rheumatoid arthritis, complicating the assessment of symptoms and treatment response.

This does not mean that fibromyalgia is simply a psychological problem or that the person's pain is imaginary.

Pain is a real experience that can involve different biological mechanisms. More than one mechanism may contribute to symptoms in the same person.

This distinction matters because therapies targeting synovial inflammation may not adequately address pain caused predominantly by other processes.

A patient with active inflammatory arthritis may require adjustment of disease-modifying treatment. Someone with relatively well-controlled inflammation but substantial nociplastic pain may benefit from another combination of interventions.

Both situations deserve appropriate clinical assessment and care.

What a 2026 Vietnamese Study Reveals About Fibromyalgia

A study published on June 19, 2026, in Rheumatology Advances in Practice provides particularly relevant evidence from Viet Nam. [4]

Researchers examined 187 adults with rheumatoid arthritis attending the Center for Rheumatology at Bach Mai Hospital in Hanoi between January 2024 and April 2025.

They assessed concomitant fibromyalgia using the 2016 American College of Rheumatology criteria and examined its relationship with rheumatoid arthritis disease activity, quality of life, and treatment patterns.

Among the participants, 64 people, or 34.2%, met the criteria for fibromyalgia.

Patients with concomitant fibromyalgia had substantially higher scores on the 28-joint Disease Activity Score incorporating C-reactive protein, a commonly used composite measure of rheumatoid arthritis activity.

The mean score was 5.54 in the group with fibromyalgia compared with 3.11 in those without it.

The difference was particularly influenced by symptom-related components, including tender joint counts, pain, and patient-reported assessments.

Importantly, objective inflammatory measures, including swollen joint counts and C-reactive protein, also differed between the groups, although those differences were comparatively smaller.

This distinction matters.

The study does not establish that patients with fibromyalgia had no active inflammation. Instead, it suggests that pain-related components can substantially influence composite rheumatoid arthritis disease activity assessments.

Patients with concomitant fibromyalgia also reported poorer quality of life.

The researchers identified differences in medication use. Patients meeting fibromyalgia criteria were more likely to receive corticosteroids and less likely to receive disease-modifying antirheumatic medicines.

These findings raise clinically important questions about how symptoms are assessed and how treatment decisions are made.

However, the research was a cross-sectional study conducted at a single specialist center.

The finding that 34.2% of participants met fibromyalgia criteria should not be interpreted as a nationally representative prevalence estimate for all people with rheumatoid arthritis in Viet Nam.

The study also cannot establish that fibromyalgia caused the observed prescribing patterns or that individual treatment decisions were inappropriate.

Its value lies in highlighting a problem that can be overlooked: a high composite disease activity score may reflect a combination of inflammatory and noninflammatory symptoms.

Recognizing that distinction may help clinicians select more appropriate interventions, avoid unnecessary treatment escalation, and ensure that continuing inflammation is not missed.

Disease Activity Scores Need Clinical Interpretation

Standardized disease activity measures are important tools in rheumatoid arthritis care.

Depending on the instrument, they may combine tender and swollen joint counts, inflammatory markers, patient assessments, and other clinical information.

These measures support treat-to-target management, help monitor progress, and identify patients who may require treatment adjustment.

However, no single score captures every aspect of a complex clinical condition.

A person with coexisting fibromyalgia may have substantial tenderness and report severe pain despite relatively limited synovial inflammation.

Conversely, clinically important synovitis may be present in someone whose pain is modest or whose routine inflammatory markers are normal.

The appropriate response is not to abandon standardized assessment.

It is to interpret the results alongside the physical examination, swollen joint findings, treatment history, laboratory results, and imaging when clinically indicated.

Musculoskeletal ultrasound may help clarify the presence of synovitis in selected patients when uncertainty remains. However, it is not necessary in every case and does not replace clinical judgment.

The clinician should consider whether persistent pain is associated primarily with active inflammation, previous structural damage, another musculoskeletal condition, or altered pain processing.

These mechanisms can coexist.

Escalating immunosuppressive treatment unnecessarily may increase medication-related risks without adequately addressing the dominant pain mechanism.

Failing to recognize persistent inflammation, on the other hand, may allow continued joint damage.

Good rheumatoid arthritis care requires distinguishing these situations rather than assuming that pain intensity alone determines the treatment needed.

What the October 2026 Evidence Adds to Lifestyle Medicine

An important new systematic literature review, published online on October 8, 2026, in EULAR Rheumatology Open, examined multifactorial lifestyle interventions in adults with rheumatoid arthritis. [5]

The researchers identified 12 studies involving a total of 660 participants.

The interventions combined several lifestyle-related components, including dietary changes, physical activity, sleep, psychological well-being, stress-related approaches, or other health behaviors.

Some studies reported improvements in disease activity, pain, fatigue, physical function, or quality of life. Two studies suggested potential advantages of multifactorial interventions over single-component approaches.

However, the findings were not consistent across studies.

The evidence was limited by relatively small samples, differences in patient characteristics, variation in the interventions and outcomes assessed, and methodological concerns.

Because of this heterogeneity, the researchers synthesized the findings narratively rather than producing a single pooled estimate of treatment benefit.

The review concluded that multifactorial lifestyle interventions may improve selected outcomes, but the available evidence remains insufficient to establish reliable effects across all important clinical measures.

Larger, well-designed trials are needed to determine which interventions are effective, for whom, under what circumstances, and how they can be implemented in routine rheumatoid arthritis care.

This evidence is particularly relevant to Lifestyle Medicine because it supports a balanced interpretation.

A comprehensive approach addressing several behaviors may be reasonable, particularly when a person has multiple health needs. However, combining nutrition, exercise, sleep support, and stress-related interventions does not automatically produce greater benefits than providing the most appropriate individual interventions.

Nor do the findings establish that multifactorial lifestyle programs can replace disease-modifying therapy.

For VLMA, the educational opportunity is to distinguish interventions that improve general health and function from those with demonstrated effects on inflammatory disease activity and long-term joint outcomes.

Lifestyle Medicine Can Help Address Function, Fatigue, and Sleep

Persistent pain can affect physical activity, sleep, concentration, emotional well-being, relationships, and the ability to work.

These consequences may remain important even when inflammatory disease activity is better controlled.

Lifestyle Medicine can contribute by addressing modifiable factors influencing physical function and the experience of living with chronic pain.

Appropriate physical activity may improve muscle strength, cardiovascular fitness, and confidence in movement.

Sleep assessment may identify disturbances contributing to fatigue, reduced concentration, or poor daily functioning. When a sleep disorder is suspected, appropriate clinical investigation and treatment may be needed.

Psychological interventions, including appropriately delivered cognitive behavioral approaches, may help selected patients manage the burden of persistent pain and improve coping and functioning.

The American College of Rheumatology's integrative treatment guideline conditionally recommends standardized self-management programs and cognitive behavioral or mind-body approaches as supportive interventions for rheumatoid arthritis. However, much of the supporting evidence is of low or very low certainty. [2]

These interventions should not be presented as direct treatments for synovial inflammation or structural joint damage.

They also should not be interpreted as suggesting that persistent pain is simply caused by stress or negative thinking.

Pain can involve biological, psychological, and social processes, and effective care may require attention to several mechanisms.

For someone with rheumatoid arthritis and coexisting fibromyalgia, a carefully selected combination of physical activity, education, sleep support, and other evidence-based interventions may be more appropriate than repeatedly increasing corticosteroids without reassessment.

The response must still depend on the clinical findings. Continuing joint swelling, systemic symptoms, and other indications of active disease require appropriate attention.

The objective is not simply to reduce a numerical pain score. It is to help the person function safely, participate in everyday activities, and maintain quality of life.

Nutrition Should Support Health Without Promising to Control Autoimmunity

Diet is frequently discussed in rheumatoid arthritis, and patients may encounter claims that particular foods can reduce inflammation or eliminate the need for medication.

Some adopt highly restrictive diets in the hope of achieving remission.

The available evidence does not support presenting dietary change as an established replacement for disease-modifying treatment.

The American College of Rheumatology conditionally recommends a Mediterranean-style dietary pattern over no formally defined diet for people with rheumatoid arthritis. [2]

This recommendation reflects limited evidence of potential improvement in pain, alongside broader cardiovascular benefits of a healthy dietary pattern.

Importantly, the evidence does not consistently demonstrate substantial improvements in rheumatoid arthritis disease activity or physical function from a specific dietary pattern alone.

The guideline also conditionally recommends against routinely adopting other formally defined restrictive diets specifically to manage rheumatoid arthritis because their disease-specific benefits have not been consistently established.

Similarly, it favors established dietary guidance over routinely adding supplements specifically for rheumatoid arthritis management.

These recommendations require appropriate interpretation.

Supplements may still be necessary for documented nutritional deficiencies or other clinical indications. Folic acid supplementation, for example, is an established component of appropriate methotrexate treatment and should not be confused with unproven commercial supplements promoted for autoimmune disease.

A balanced dietary pattern emphasizing vegetables, fruit, whole grains, legumes, appropriate protein sources, and healthier fats can support general health.

In Viet Nam, such a pattern can be adapted to familiar foods and household meals rather than requiring imported products or strict adherence to an international menu.

The aim should be nutritional adequacy, cardiovascular health, and sustainability.

There is no established evidence that eliminating gluten, dairy products, meat, or other entire food groups will reliably suppress rheumatoid arthritis in every patient.

Unnecessary restriction may reduce nutritional intake, increase food-related anxiety, or interfere with normal social activities.

For patients experiencing substantial weight loss, frailty, anemia, or other nutritional concerns, restrictive eating may be particularly inappropriate.

The appropriate contribution of Lifestyle Medicine is to support evidence-based nutritional care without promoting unproven dietary cures for autoimmune disease.

Smoking Cessation and Cardiovascular Health Remain Important

Rheumatoid arthritis is associated with an increased burden of cardiovascular disease.

Chronic systemic inflammation contributes to cardiovascular risk, alongside familiar factors such as hypertension, dyslipidemia, diabetes, smoking, and obesity.

Smoking is also an established environmental risk factor associated with rheumatoid arthritis development, particularly in genetically susceptible individuals.

For people already living with rheumatoid arthritis, smoking cessation remains important for cardiovascular, respiratory, and general health.

However, quitting smoking should not be presented as a guaranteed method of achieving rheumatoid arthritis remission.

Healthcare professionals should also consider appropriate assessment and management of blood pressure, lipid levels, glucose regulation, and other cardiovascular risk factors.

Physical activity, nutrition, and tobacco cessation may contribute meaningfully to this process, but they do not replace clinically indicated cardiovascular medication or disease-modifying treatment.

Bone health is another relevant consideration, particularly among people with reduced mobility, postmenopausal women, and those receiving prolonged glucocorticoid treatment.

These additional needs may require assessment and treatment beyond the management of inflammatory joint disease.

The aim is comprehensive care that addresses the person's actual risks without assuming every problem can be managed through one lifestyle intervention.

Medication Safety Is Essential to Effective Rheumatoid Arthritis Care

Disease-modifying antirheumatic drugs are central to rheumatoid arthritis treatment because they target the inflammatory disease process and help prevent progressive joint damage.

However, different medication classes require different monitoring and safety precautions.

Methotrexate is among the most frequently used conventional synthetic disease-modifying medicines.

Appropriate monitoring commonly includes blood counts, liver function, and kidney function, with frequency determined by the treatment stage and the patient's clinical circumstances.

A particularly important safety issue is the frequency of administration.

Methotrexate used for rheumatoid arthritis is generally administered once weekly, not daily.

Confusion between weekly and daily administration can cause severe or potentially fatal toxicity.

The European Medicines Agency introduced additional risk-minimization measures in 2019 to reduce serious dosing errors involving methotrexate used for inflammatory diseases. [6]

Clear prescribing instructions, patient education, medication review, and appropriate follow-up are therefore essential.

Patients should understand their prescribed schedule and the purpose of any accompanying folic acid supplementation.

Other disease-modifying treatments have different safety considerations.

Biological and targeted synthetic medicines may require assessment of infection risks, associated diseases, previous treatment responses, and other patient characteristics.

Janus kinase inhibitors deserve particular attention.

European regulatory authorities have introduced measures to reduce risks involving major cardiovascular events, malignancies, venous thromboembolism, serious infections, and other adverse outcomes in selected patient groups. [7]

These concerns do not mean that Janus kinase inhibitors are unsuitable for every patient. Treatment decisions should consider individual risk, therapeutic alternatives, relevant regulatory requirements, and expected benefits.

Glucocorticoids also require careful management.

They can provide rapid relief of inflammation in selected circumstances, but prolonged exposure is associated with important risks, including osteoporosis, infection, hypertension, diabetes, and other complications.

The updated EULAR recommendations emphasize using glucocorticoids for as short a period as clinically feasible when they are used during initiation or adjustment of conventional synthetic disease-modifying treatment. [1]

Repeatedly prescribing corticosteroids in response to persistent pain without reassessing the source of symptoms may expose patients to unnecessary harm.

At the same time, people receiving prolonged glucocorticoid treatment should not stop medication abruptly without appropriate medical guidance.

The objective is effective disease control with appropriate medication safety, not treatment withdrawal as an independent goal.

Infection Prevention Has Particular Relevance in Viet Nam

Some rheumatoid arthritis treatments affect immune function, making infection prevention an important consideration.

Before initiating certain biological or targeted synthetic disease-modifying medicines, healthcare professionals need to assess relevant infection risks and determine whether screening, vaccination, preventive treatment, or specialist consultation is appropriate.

Tuberculosis is one such concern.

The 2022 EULAR recommendations on screening and prevention of chronic and opportunistic infections recommend screening for latent tuberculosis before biological or targeted synthetic disease-modifying treatment. [8]

Screening may also be considered before other immunosuppressive treatments according to the person's risk, medication regimen, and applicable professional guidance.

Hepatitis B is another important issue in Viet Nam.

Certain immunosuppressive treatments can lead to reactivation of hepatitis B infection, including in some people with previously resolved infection.

On June 16, 2026, the Ministry of Health issued Decision No. 1740/QĐ-BYT, updating the national guidance on diagnosis and treatment of hepatitis B virus infection. [9]

The guidance replaced Decision No. 3310/QĐ-BYT issued in 2019 and applies to healthcare facilities in Viet Nam.

It includes recommendations concerning assessment and prevention of hepatitis B reactivation in people receiving immunosuppressive treatment or chemotherapy.

Appendix 3 addresses reactivation risk according to hepatitis B infection status and the immunosuppressive treatment involved.

For patients requiring rheumatoid arthritis treatment, this is clinically relevant because different medicines carry different levels of risk.

Therapies affecting B cells, such as rituximab, deserve particular attention because they can be associated with substantial hepatitis B reactivation risk.

Appropriate assessment may involve hepatitis B surface antigen and hepatitis B core antibody testing, with additional investigations, including hepatitis B viral load, when indicated.

Decisions about antiviral prophylaxis or monitoring depend on the person's infection status, treatment-related risk, and applicable guidance.

The purpose is to identify risks that may change the treatment plan.

These decisions should be coordinated by the responsible clinicians, with specialist involvement when appropriate.

Vaccination status and other infection-prevention needs should also be reviewed according to the person's treatment and immune status.

A patient receiving immunosuppressive therapy who develops fever, significant respiratory symptoms, or a new acutely inflamed joint may require prompt assessment for infection.

Such symptoms should not automatically be attributed to rheumatoid arthritis activity.

Lifestyle-related measures may support general health, but they cannot replace necessary infection screening, prophylaxis, vaccination, or medical treatment.

Translating International Evidence Into Care in Viet Nam

Viet Nam has an established professional reference for rheumatoid arthritis.

On January 25, 2014, the Ministry of Health issued Decision No. 361/QĐ-BYT, approving the Guidelines for Diagnosis and Treatment of Musculoskeletal Diseases. The guideline collection includes rheumatoid arthritis and relevant principles of assessment and treatment. [10]

The material was subsequently published by the Medical Publishing House in 2016. This publication year should be distinguished from the original Ministry of Health decision.

The guidance provides an important national reference, although international evidence and available treatment options have continued to evolve.

The EULAR recommendations published in 2026 offer updated international perspectives on disease-modifying treatment and physical activity.

They can inform professional education and clinical review, but they do not automatically replace Vietnamese guidance or become legally binding national treatment requirements.

Their application requires consideration of the individual's clinical circumstances, medicines authorized for use in Viet Nam, professional responsibilities, and resources available in each healthcare setting.

Access to care is also relevant.

Some patients may receive treatment at specialist rheumatology centers, while others face difficulties obtaining specialist assessment, rehabilitation, advanced therapies, or regular follow-up.

Travel costs, employment obligations, medication expenses, and the burden of repeated monitoring may affect treatment continuity.

These circumstances should not automatically be interpreted as failures of patient motivation.

Someone who misses follow-up because transportation is difficult may need a different response from a person experiencing medication adverse effects or misunderstanding the treatment plan.

The 2026 study from Bach Mai Hospital demonstrates the importance of considering how symptoms and clinical assessments interact in a Vietnamese patient population.

However, a single-center study cannot establish that the same frequency or pattern of fibromyalgia occurs throughout Viet Nam.

Further research across different healthcare settings could help clarify variations in pain mechanisms, treatment access, medication use, and patient-reported outcomes.

The opportunity is to use international evidence and local research together, without treating either as sufficient to answer every question about clinical practice in Viet Nam.

Coordinated Care Should Respond to Different Needs

Rheumatoid arthritis care may involve several healthcare professionals, depending on the patient's clinical needs.

Rheumatologists play a central role in diagnosis, assessment of disease activity, and decisions concerning disease-modifying treatment.

Appropriately qualified rehabilitation professionals may help patients improve strength, mobility, endurance, and physical function.

Occupational therapy may support joint protection, adaptation of everyday activities, assistive devices, and strategies for managing difficulties at home or work.

Clinical nutrition professionals may provide individualized dietary support when nutritional problems, cardiovascular risk factors, or other conditions are present.

Nurses and pharmacists can contribute to patient education, medication safety, monitoring, and continuity of care within their professional responsibilities.

Mental health professionals may help address depression, anxiety, persistent pain-related distress, or other concerns when clinically indicated.

The objective is not to refer every patient to every service.

It is to identify needs that require additional expertise and connect the person with appropriate care.

A patient whose inflammation is well controlled but who cannot open containers or perform tasks at work may benefit from functional assessment and occupational support.

Someone experiencing widespread pain, fatigue, and poor sleep may require further assessment for fibromyalgia or other pain mechanisms.

A patient with persistent swollen joints despite treatment may need rheumatology reassessment and modification of disease-modifying therapy.

These situations may produce similar complaints, but their clinical management is not necessarily the same.

A coordinated approach helps avoid responding to every problem with a single intervention.

Measuring Improvement Requires More Than a Lower Pain Score

Pain reduction is important, but it is not sufficient to evaluate rheumatoid arthritis care.

A person may report less pain after receiving analgesic or corticosteroid treatment while underlying inflammation remains active.

Another may achieve good inflammatory disease control but continue experiencing fatigue, widespread pain, or functional limitations.

These situations require different interpretations.

For inflammatory disease management, relevant measures may include swollen joint counts, validated composite disease activity assessments, laboratory markers, and evidence of structural progression when appropriate.

Medication safety, adverse effects, and treatment continuity also matter.

For physical activity and rehabilitation interventions, outcomes may include strength, physical function, activity levels, fatigue, sleep, participation in everyday activities, and patient-reported quality of life.

The measures should reflect the purpose of the intervention.

An exercise program should not claim to have prevented joint damage simply because participants report less pain or walk farther.

Likewise, an improvement in a composite disease activity score does not necessarily mean that every pain mechanism or functional problem has resolved.

The Vietnamese fibromyalgia study provides a reminder that the components of a disease activity score deserve attention, not only the final number.

Healthcare organizations may also examine whether people with suspected inflammatory arthritis receive appropriate assessment, whether disease-modifying treatment is initiated when indicated, and whether treatment response and safety are reviewed.

For patients, meaningful improvement may involve returning to work, dressing independently, walking comfortably, or completing daily tasks with less pain and fatigue.

These outcomes deserve attention alongside the prevention of inflammation-related joint damage.

Good care requires both accurate assessment of the underlying disease and an understanding of what matters to the person living with it.

Professional and Legal Considerations in Viet Nam

Lifestyle Medicine can contribute to rheumatoid arthritis care through evidence-based education, appropriate physical activity, nutritional support, behavior-change strategies, and attention to wider factors influencing health.

However, diagnosing rheumatoid arthritis, assessing inflammatory disease activity, prescribing disease-modifying medicines, and making decisions concerning immunosuppressive treatment are regulated clinical activities.

In Viet Nam, the Law on Medical Examination and Treatment No. 15/2023/QH15, as amended and reflected in Consolidated Document No. 26/VBHN-VPQH dated February 26, 2026, provides the principal legal framework for medical examination and treatment. [11]

Healthcare professionals must act within their qualifications, professional competence, and legally authorized scopes of practice.

Completion of a Lifestyle Medicine course, professional certification, or health-coaching program does not independently authorize someone to diagnose autoimmune disease, prescribe immunosuppressive medicine, or modify an individual patient's treatment plan.

Clinical exercise interventions, disease-specific nutritional management, and psychological therapies must also be provided by appropriately qualified professionals within the applicable legal and institutional framework.

International recommendations from EULAR and the American College of Rheumatology may inform professional education and clinical decision-making, but they do not automatically become Vietnamese regulatory requirements or establish the local approval, availability, reimbursement, or suitability of particular medicines.

Organizations must also protect patient information when collecting clinical histories, laboratory results, medication records, and patient-reported outcomes.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, establish relevant requirements for the processing and protection of personal data. [12,13]

Educational publications should not disclose identifiable patient information without satisfying the applicable legal basis, confidentiality, and consent requirements.

For the Vietnam Lifestyle Medicine Alliance (VLMA), the appropriate contribution is professional education, scientific knowledge exchange, and critical interpretation of evidence.

VLMA is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. Its role is to support evidence-based Lifestyle Medicine through education, professional capability development, and responsible collaboration.

Potential educational topics include safe physical activity in inflammatory arthritis, interpretation of persistent pain, evidence-based lifestyle support for fatigue and physical function, and recognition of medication-safety concerns relevant to chronic rheumatological care.

Such activities would benefit from collaboration with appropriately qualified rheumatologists, rehabilitation professionals, clinical nutrition professionals, pharmacists, and other relevant healthcare practitioners.

These are potential directions for professional education rather than claims that VLMA currently provides rheumatoid arthritis diagnosis, treatment, medication management, or clinical rehabilitation services.

The purpose is to strengthen professional understanding while respecting the expertise and legal responsibilities required for safe clinical care.

Better Rheumatoid Arthritis Care Requires More Than Controlling Pain

Rheumatoid arthritis illustrates why evidence-based Lifestyle Medicine must remain connected to established clinical treatment.

Appropriate physical activity can improve physical function, fitness, and quality of life. Nutrition, smoking cessation, sleep support, and attention to psychological well-being may help address other important health needs.

These interventions have value, but they do not replace disease-modifying treatment when rheumatoid arthritis requires pharmacological control.

At the same time, increasing immunosuppressive medication is not always the appropriate response to persistent pain.

Some people continue to experience widespread pain, fatigue, or functional limitations despite improved control of synovial inflammation. Understanding the possible causes can help clinicians select more appropriate interventions while avoiding unnecessary medication-related harm.

The EULAR recommendations published in 2026 reinforce the importance of both effective disease-modifying treatment and individualized physical activity.

The Vietnamese study from Bach Mai Hospital provides a timely reminder that pain assessment and inflammatory disease assessment are related but not identical.

For healthcare professionals in Viet Nam, a responsible approach involves accurate diagnosis, timely treatment, careful monitoring, appropriate rehabilitation, and recognition of circumstances that affect access to care.

The purpose of Lifestyle Medicine is not to offer an alternative to rheumatology treatment or suggest that autoimmune disease can be reliably controlled through healthier habits alone.

Its contribution lies in addressing needs that remain alongside inflammatory disease management, while respecting the limits of current evidence and the importance of treatment safety.

Better care should prevent avoidable joint damage, support physical function, recognize different causes of persistent pain, and help people participate more fully in everyday life.

That is where evidence-based Lifestyle Medicine can make a meaningful contribution to rheumatoid arthritis care in Viet Nam.

Selected References

1. Smolen JS, Edwards CJ, Konzett V, et al. EULAR Recommendations for the Management of Rheumatoid Arthritis With Synthetic and Biologic Disease-Modifying Antirheumatic Drugs: 2025 Update. Annals of the Rheumatic Diseases. 2026;85(6):991–1009. Published online March 12, 2026. DOI: 10.1016/j.ard.2026.01.023.

2. England BR, Smith BJ, Baker NA, et al. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis & Rheumatology. 2023;75(8):1299–1311. DOI: 10.1002/art.42507.

3. Rausch Osthoff AK, Vliet Vlieland TPM, Ferreira RJO, et al. EULAR Recommendations for Physical Activity in People With Inflammatory Arthritis and Osteoarthritis: 2025 Update. Annals of the Rheumatic Diseases. 2026;85(6):1026–1038. Published online April 26, 2026. DOI: 10.1016/j.ard.2026.03.006.

4. Tran Thi N, Dang Thi H, Vu Thi H, Nguyen Thi Phuong T. Impact of Concomitant Fibromyalgia on Disease Activity Assessment and Quality of Life in Vietnamese Patients With Rheumatoid Arthritis. Rheumatology Advances in Practice. 2026;10(3). Published June 19, 2026. DOI: 10.1093/rap/rkag067.

5. Curran M, Durkan K, Ahmed A, McCann K, Kennedy N, Tierney A. Multifactorial Lifestyle Interventions in Rheumatoid Arthritis: A Systematic Literature Review. EULAR Rheumatology Open. 2026;2(4):100254. Published online October 8, 2026. DOI: 10.1016/j.ero.2026.100254.

6. European Medicines Agency. New Measures to Avoid Potentially Fatal Dosing Errors With Methotrexate for Inflammatory Diseases. August 22, 2019.

7. European Medicines Agency. EMA Confirms Measures to Minimise Risk of Serious Side Effects With Janus Kinase Inhibitors for Chronic Inflammatory Disorders. 2023.

8. Fragoulis GE, Nikiphorou E, Dey M, et al. 2022 EULAR Recommendations for Screening and Prophylaxis of Chronic and Opportunistic Infections in Adults With Autoimmune Inflammatory Rheumatic Diseases. Annals of the Rheumatic Diseases. 2023;82(6):742–753. DOI: 10.1136/ard-2022-223335.

9. Ministry of Health of Viet Nam. Decision No. 1740/QĐ-BYT Issuing the Guidelines for Diagnosis and Treatment of Hepatitis B Virus Infection. June 16, 2026. Including Appendix 3 on hepatitis B reactivation prevention during immunosuppressive therapy or chemotherapy.

10. Ministry of Health of Viet Nam. Decision No. 361/QĐ-BYT Issuing the Guidelines for Diagnosis and Treatment of Musculoskeletal Diseases. January 25, 2014.

11. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH: Law on Medical Examination and Treatment. February 26, 2026.

12. National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. June 26, 2025. Effective January 1, 2026.

13. Government of Viet Nam. Decree No. 356/2025/NĐ-CP Detailing Certain Articles and Measures for Implementing the Law on Personal Data Protection. December 31, 2025. Effective January 1, 2026.

14. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care & Research. 2021;73(7):924–939. DOI: 10.1002/acr.24596.

15. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443–451. First published online October 28, 2025. DOI: 10.1177/15598276251379821.

Editorial and Professional Scope Note

This article presents the professional perspective of the Vietnam Lifestyle Medicine Alliance on the contribution and limitations of evidence-based Lifestyle Medicine in rheumatoid arthritis care, including physical activity, persistent pain, functional health, disease-modifying treatment, and medication safety. It reflects scientific and regulatory information reviewed as of October 30, 2026.

The article is intended for professional information, education, and scientific knowledge exchange. It does not constitute an official clinical practice guideline, individualized medical advice, a diagnostic assessment, an exercise prescription, a nutritional treatment plan, a medication recommendation, or a treatment protocol. The introductory scenario is hypothetical and does not describe an actual VLMA clinical activity.

Lifestyle interventions may support health and physical function but must not delay or replace appropriate diagnosis, disease-modifying treatment, clinical monitoring, or specialist care when indicated.

Persistent pain does not necessarily indicate active rheumatoid arthritis, but it also does not exclude ongoing synovitis, structural damage, infection, or another medical condition. Individualized clinical assessment is necessary before treatment decisions are made.

Medication selection, dosing, monitoring, and adjustment, including the use of methotrexate, biological or targeted synthetic treatments, and glucocorticoids, require appropriately qualified healthcare professionals. Patients should not independently interrupt or modify prescribed treatment.

International guidelines and regulatory communications are referenced for educational purposes. Their inclusion does not imply automatic adoption as Vietnamese clinical standards or confirm the local approval, availability, reimbursement, or suitability of particular medicines or interventions.

VLMA is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. It is not a licensed medical examination or treatment facility, rheumatology service provider, rehabilitation facility, medical licensing authority, or healthcare accreditation organization. VLMA does not independently diagnose rheumatoid arthritis or fibromyalgia, prescribe medication, assess individual disease activity, or provide clinical follow-up.

Clinical assessment, diagnosis, prescribing, rehabilitation, and follow-up must remain under the responsibility of appropriately authorized healthcare professionals and facilities acting within their lawful scopes of practice.

Patient information must be handled in accordance with applicable confidentiality and personal data protection requirements.

Scientific publications and professional recommendations are included to support education and knowledge exchange. Their inclusion does not imply that VLMA has formally adopted, clinically implemented, evaluated, validated, or certified any rheumatoid arthritis treatment or Lifestyle Medicine program discussed in this article.