EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis
Nagy, György; Roodenrijs, Nadia M T; Welsing, Paco M J; Kedves, Melinda; Hamar, Attila; van der Goes, Marlies C; Kent, Alison; Bakkers, Margot; Pchelnikova, Polina; Blaas, Etienne; Senolt, Ladislav; Szekanecz, Zoltan; Choy, Ernest H; Dougados, Maxime; Jacobs, Johannes Wg; Geenen, Rinie; Bijlsma, Johannes Wj; Zink, Angela; Aletaha, Daniel; Schoneveld, Leonard; van Riel, Piet; Dumas, Sophie; Prior, Yeliz; Nikiphorou, Elena; Ferraccioli, Gianfranco; Schett, Georg; Hyrich, Kimme L; Mueller-Ladner, Ulf; Buch, Maya H; McInnes, Iain B; van der Heijde, Désirée; van Laar, Jacob 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 addressed clinical questions
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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, fibromyalgia, inflammation, rheumatoid, ultrasonography, General Biochemistry,Genetics and Molecular Biology, Rheumatology, Immunology and Allergy, Immunology, Journal Article
ISSN: 0003-4967
Publisher: BMJ Publishing Group
Note: Publisher Copyright: © Author(s) (or their employer(s)) 2022
(Peer reviewed)