EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis

Nagy, G. et al. (2022) EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Annals of the Rheumatic Diseases, 81(1), pp. 20-33. (doi: 10.1136/annrheumdis-2021-220973) (PMID:34407926) (PMCID:PMC8761998)

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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 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.

Item Type:Articles
Keywords:Ultrasonography, inflammation, arthritis, rheumatoid, fibromyalgia.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McInnes, Professor Iain
Authors: Nagy, G., Roodenrijs, N. M.T., Welsing, P. M.J., Kedves, M., Hamar, A., van der Goes, M. C., Kent, A., Bakkers, M., Pchelnikova, P., Blaas, E., Senolt, L., Szekanecz, Z., Choy, E. H., Dougados, M., Jacobs, J. W.G., Geenen, R., Bijlsma, J. W.J., 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., and van Laar, J. M.
College/School:College of Medical Veterinary and Life Sciences > School of Infection & Immunity
Research Centre:College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
Journal Name:Annals of the Rheumatic Diseases
Publisher:BMJ Publishing Group
ISSN:0003-4967
ISSN (Online):1468-2060
Published Online:18 August 2021
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Annals of the Rheumatic Diseases 81(1): 20-33
Publisher Policy:Reproduced under a Creative Commons License

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