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, General Biochemistry,Genetics and Molecular Biology
ISSN: 0003-4967
Publisher: BMJ Publishing Group
Note: Funding Information: Acknowledgements The Task Force is grateful for the support of EULAR and for the outstanding assistance of the EULAR Secretariat, especially Julia Rautenstrauch, Patrizia Jud and Simona Lupatin. The Task Force acknowledges the contribution of Maria J H de Hair (rheumatology postdoctoral fellow) and Loriane Gutermann (pharmacist), who left the Task Force due to their new positions. Publisher Copyright: © Author(s) (or their employer(s)) 2022
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