EULAR 2025 Update: Movement Care for Arthritis Patients

For people with inflammatory arthritis or osteoarthritis, the updated EULAR guidance changes the clinical job from "tell patients to exercise" to "help them build movement into daily care." The 2025 update puts physical-activity promotion, measurement, less sedentary time, individual adaptation, and behavior support into a more explicit standard-of-care framework. It does not claim that a smartwatch has solved adherence. It says clinicians should treat movement behavior as something worth assessing and supporting.

The 2025 EULAR update, published in 2026, retains the basic message that people with inflammatory arthritis and osteoarthritis should be physically active. Its newer emphasis reflects evidence on technology-enabled and combined educational or behavioral interventions, plus a broader shift toward reducing sedentary behavior. The document contains four overarching principles and 11 recommendations. Task-force ratings were high: agreement ranged from 9.0 to 9.8 out of 10, estimated impact from 8.3 to 9.2, and feasibility from 7.2 to 8.5.

What changed: implementation moved into the treatment conversation

The update's meaningful change is practical rather than miraculous. It asks clinicians to promote activity as routine care, measure it when useful, address sitting time, and adapt the dose and type of activity to the person's symptoms, function, preferences, and circumstances. Behavioral support and technology can help with follow-through.

That framing matters because "exercise more" is not an intervention plan. A plan might include noticing prolonged sitting, using an activity monitor for feedback, setting a realistic movement target, and adjusting the plan when pain, fatigue, or disease activity changes. EULAR's message is adaptation, not avoidance. The guideline record available publicly does not provide enough detail to reconstruct the exact wording or grading of every recommendation, so claims about its contents should remain at this level.

Movement support belongs in arthritis care as a repeatable clinical practice, not as a vague lifestyle reminder handed out on the way to the parking lot.

The evidence base supports activity, with different strength across conditions

The broad rationale is stronger than the evidence for any particular app or coaching format. A 2022 set of systematic reviews and meta-analyses informing earlier EULAR lifestyle guidance found that physical exercise and body weight were linked to disease-specific outcomes across rheumatic and musculoskeletal diseases. That supports placing physical activity inside routine management. It does not identify one tracker, counseling method, or behavior-change technique as the winner.

Rheumatoid arthritis has the densest direct evidence among the studies considered here. A 2024 intervention study of postmenopausal women with rheumatoid arthritis tested reducing sedentary behavior and reported clinical and cardiometabolic effects. The available report does not provide the effect sizes or confidence intervals needed to judge their magnitude, but the study matters because it directly tested the guideline's newer sit-less emphasis rather than treating sedentary behavior as background scenery.

Observational evidence also makes sitting and activity patterns clinically relevant in rheumatoid arthritis. In a cross-sectional study of 82 postmenopausal women with rheumatoid arthritis, Meireles and colleagues used seven days of accelerometry and vascular ultrasound. After accounting for age, body mass index, and disease activity, longer sedentary bouts of more than 60 minutes and total sedentary time were inversely associated with vascular measures. These are associations with surrogate vascular outcomes, not proof that changing sitting time will prevent cardiovascular events.

A separate 2021 cross-sectional accelerometer study of 34 people with rheumatoid arthritis found that participants with low disease activity averaged 17.2 minutes per day of moderate-to-vigorous physical activity, compared with 10.6 minutes per day among those with moderate or high disease activity; the difference was statistically significant. The study supports tailoring activity support to disease status. It cannot establish whether lower activity worsened disease activity, higher disease activity reduced activity, or both occurred.

Why tracking can help—and why it is not a treatment by itself

For hip and knee osteoarthritis, a 2021 study of working-age adults examined activity patterns, self-reported function, and adherence to a wearable activity tracker over 12 weeks. The wearable-tracker study supports the feasibility of self-monitoring in this population. It did not provide a randomized test showing that tracker use caused a large increase in objectively measured activity or a durable benefit after the monitoring period ended.

That distinction is easy to blur because wearables make excellent marketing props. A device can measure behavior, prompt awareness, and support a plan; it cannot supply the missing evidence that its use reliably produces lasting change for every person with osteoarthritis. The EULAR update supports technology as one implementation option, not as a replacement for individual clinical judgment.

Whole-day patterns may also matter more than a single weekly exercise total. A 2025 cross-sectional study of 203 adults with rheumatoid arthritis used objective measures and latent-class analysis to identify 24-hour profiles of activity, sedentary behavior, and sleep. The study shows that these behaviors cluster together in real life. It does not show that moving a person from one profile to another will improve symptoms or long-term outcomes.

Context can shift these patterns quickly. In a within-subjects accelerometer study of postmenopausal women with rheumatoid arthritis, Pinto and colleagues found more prolonged sitting during COVID-19 social-distancing measures than before the pandemic and also assessed pain, fatigue, and health-related quality of life. The result illustrates why clinicians should ask about daily routines, especially when routines change. Pandemic restrictions were a specific environment, so the finding should not become a universal prediction about every disruption.

Education has a role, but correlation is not a behavior-change trial

Education fits the updated framework because people need enough knowledge to make an activity plan workable. In axial spondyloarthritis, a 2025 correlational study linked poorer physical-activity knowledge with lower activity and worse disease. It supports identifying knowledge gaps. It does not prove that an awareness campaign, an app, or a single educational session will improve activity or disease outcomes.

Evidence extends beyond adult rheumatoid arthritis, but generalization has limits. A 2026 multicenter study used eight-day hip-worn accelerometry to describe sedentary time, light activity, and moderate-to-vigorous activity in young people aged 10 to 20 years with juvenile idiopathic arthritis and matched controls. The ActiMON study shows that device-measured movement behavior is relevant in pediatric inflammatory arthritis. It does not directly answer how adult EULAR implementation should work.

What the update can—and cannot—justify

The evidence supports active clinical attention to movement, sitting time, measurement, and behavior support. Confidence is strongest for rheumatoid arthritis, more limited for hip and knee osteoarthritis implementation questions, and thinner for direct intervention evidence in axial spondyloarthritis, psoriatic arthritis, and hand osteoarthritis.

Several studies are cross-sectional or observational. They can identify patterns worth measuring, but they cannot establish cause and effect. The osteoarthritis wearable study addresses feasibility, not efficacy. The axial spondyloarthritis study addresses knowledge and associations, not an educational intervention. The sedentary-behavior trial is more directly relevant to change, yet its available abstract does not report the effect estimates needed to quantify its clinical importance.

For patients and clinicians, the sensible response is neither to wait for perfect evidence nor to buy the first gadget that promises a new life by Tuesday. Measure activity when it helps, break up sedentary time, tailor the plan to symptoms and function, and use education or technology to make follow-through easier. EULAR's update makes that support part of routine arthritis care; the science has not yet crowned a universal adherence tool.