EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis
Nagy, G.; Roodenrijs, N.M.; Welsing, P.M.; Kedves, M.; Hamar, A.; van der Goes, M.C.; Kent, A.; Bakkers, M.; Pchelnikova, P.; Blaas, E.; Senolt, L.; Szekanecz, Z.; Choy, E.; Dougados, M.; Jacobs, J.W.; Geenen, R.; Bijlsma, J.W.; Zink, A.; Aletaha, D.; Schoneveld, L.; van Riel, P.; Dumas, S.; Prior, Y.; Nikiphorou, E.; Ferraccioli, G.; Schett, G.; Hyrich, K.L.; Mueller-Ladner, U.; Buch, M.H.; McInnes, I.B.; van der Heijde, D.; van Laar, J.M.
(2022) Annals of the Rheumatic Diseases, volume 81, issue 1, pp. 20 - 33
(Article)
Abstract
Objective: To develop evidence- based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult- to- treat rheumatoid arthritis (D2T RA). Methods: An EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professionals. Two systematic literature reviews
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addressed clinical questions around diagnostic challenges, and pharmacological and non- pharmacological therapeutic strategies in D2T RA. PtCs were formulated based on the identified evidence and expert opinion. Strength of recommendations (SoR, scale A–D: A typically consistent level 1 studies and D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0–10: 0 completely disagree and 10 completely agree) of the PtCs were determined by the Task Force members. Results: Two overarching principles and 11 PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and non- pharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self- efficacy and the impact of comorbidities. The SoR varied from level C to level D. The mean LoA with the overarching principles and PtCs was generally high (8.4–9.6). Conclusions: These PtCs for D2T RA can serve as a clinical roadmap to support healthcare professionals and patients to deliver holistic management and more personalised pharmacological and non- pharmacological therapeutic strategies. High- quality evidence was scarce. A research agenda was created to guide future research
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Keywords: arthritis, immune system diseases, rheumatoid, synovitis, Rheumatology, Immunology and Allergy, Immunology, Biochemistry, Genetics and Molecular Biology(all)
ISSN: 0003-4967
Publisher: BMJ Publishing Group
Note: Publisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
(Peer reviewed)
