Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force
Josef S Smolen,Ferdinand C. Breedveld,Gerd R Burmester,Vivian P. Bykerk,Maxime Dougados,Paul Emery,Tore K Kvien,M Victoria Navarro-Compán,Susan Oliver,Monika Schoels,Marieke Scholte-Voshaar,Tanja Stamm,Michaela Stoffer,Tsutomu Takeuchi,Daniel Aletaha,Jose Louis Andreu,Martin Aringer,Martin J. Bergman,Neil Betteridge,H. Bijlsma,Harald Burkhardt,Mario H. Cardiel,Bernard Combe,Patrick Durez,João Eurico Fonseca,A. Gibofsky,Juan J. Gomez-Reino,Winfried Graninger,Pekka Hannonen,Boulos Haraoui,Marios Kouloumas,Robert Landewé,Emilio Martín-Mola,Peter Nash,Mikkel Østergaard,Andrew J. K. Östör,Pam Richards,T. Sokka-Isler,Carter Thorne,Athanasios G. Tzioufas,Ronald F van Vollenhoven,Martinus de Wit,Désirée van der Heijde +42 more
TLDR
The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.Abstract:
Background Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. Objective To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. Methods A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. Results The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (=9/10). Conclusions The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.read more
Citations
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EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update
Josef S Smolen,Robert Landewé,Ferdinand C. Breedveld,Maya H Buch,Maya H Buch,Gerd R Burmester,Maxime Dougados,Paul Emery,Paul Emery,Cécile Gaujoux-Viala,Laure Gossec,Jackie L Nam,Jackie L Nam,Sofia Ramiro,Kevin L. Winthrop,Maarten de Wit,Daniel Aletaha,Neil Betteridge,Johannes W. J. Bijlsma,Maarten Boers,Frank Buttgereit,Bernard Combe,Maurizio Cutolo,Nemanja Damjanov,Johanna M. W. Hazes,Marios Kouloumas,Tore K Kvien,Xavier Mariette,Karel Pavelka,Piet L. C. M. van Riel,Andrea Rubbert-Roth,Marieke Scholte-Voshaar,David Scott,T. Sokka-Isler,John B. Wong,Désirée van der Heijde +35 more
TL;DR: These recommendations intend informing rheumatologists, patients, national rheumology societies, hospital officials, social security agencies and regulators about EULAR's most recent consensus on the management of RA, aimed at attaining best outcomes with current therapies.
Journal ArticleDOI
2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis
Jasvinder A. Singh,Kenneth G. Saag,S. Louis Bridges,Elie A. Akl,Raveendhara R. Bannuru,Matthew C. Sullivan,Elizaveta E. Vaysbrot,Christine McNaughton,Mikala C. Osani,Robert H. Shmerling,Jeffrey R. Curtis,Daniel E. Furst,Deborah Parks,Arthur Kavanaugh,James R. O'Dell,Charles H. King,Amye Leong,Eric L. Matteson,John T. Schousboe,Barbara E. Drevlow,Seth Ginsberg,James Grober,E. William St. Clair,Elizabeth A. Tindall,Amy S. Miller,Timothy E. McAlindon +25 more
TL;DR: To develop a new evidence‐based, pharmacologic treatment guideline for rheumatoid arthritis (RA), a large number of patients with RA are referred to a single clinic for treatment with these medications.
Journal ArticleDOI
Diagnosis and Management of Rheumatoid Arthritis: A Review.
Daniel Aletaha,Josef S Smolen +1 more
TL;DR: A treat-to-target strategy aimed at reducing disease activity by at least 50% within 3 months and achieving remission or low disease activity within 6 months, with sequential drug treatment if needed, can prevent RA-related disability.
Journal ArticleDOI
2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis: ACR RA Treatment Recommendations
Jasvinder A. Singh,Kenneth G. Saag,S. Louis Bridges,Elie A. Akl,Raveendhara R. Bannuru,Matthew C. Sullivan,Elizaveta E. Vaysbrot,Christine McNaughton,Mikala C. Osani,Robert H. Shmerling,Jeffrey R. Curtis,Daniel E. Furst,Deborah Parks,Arthur Kavanaugh,James R. O'Dell,Charles H. King,Amye Leong,Eric L. Matteson,John T. Schousboe,Barbara E. Drevlow,Seth Ginsberg,James Grober,E. William St. Clair,Elizabeth A. Tindall,Amy S. Miller,Timothy E. McAlindon +25 more
TL;DR: To develop a new evidence‐based, pharmacologic treatment guideline for rheumatoid arthritis (RA), a large number of patients with RA are referred to a single clinic for treatment with these medications.
Journal ArticleDOI
European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update.
Laure Gossec,Josef S Smolen,Sofia Ramiro,M. de Wit,Maurizio Cutolo,Maxime Dougados,Paul Emery,Robert Landewé,Sue Oliver,Daniel Aletaha,Neil Betteridge,Jürgen Braun,G.-R. Burmester,Juan D. Cañete,Nemanja Damjanov,Oliver FitzGerald,Emma Haglund,P S Helliwell,Tore K Kvien,Rik Lories,Thomas A. Luger,Mara Maccarone,Helena Marzo-Ortega,Dennis McGonagle,Iain B. McInnes,I. Olivieri,Karel Pavelka,Georg Schett,Joachim Sieper,F. Van den Bosch,Douglas J. Veale,Jürgen Wollenhaupt,Angela Zink,D. van der Heijde +33 more
TL;DR: These recommendations provide stakeholders with an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes in PsA, based on a combination of evidence and expert opinion.
References
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Journal ArticleDOI
Modified disease activity scores that include twenty-eight-joint counts : development and validation in a prospective longitudinal study of patients with rheumatoid arthritis
M.L.L. Prevoo,M.A. van 't Hof,H.H. Kuper,M.A. van Leeuwen,L. B. A. Van De Putte,P.L.C.M. van Riel +5 more
TL;DR: The Modified DAS that included 28-joint counts were able to discriminate between high and low disease activity (as indicated by clinical decisions of rheumatologists) and are as valid as disease activity scores that include more comprehensive joint counts.
Journal ArticleDOI
EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update
Josef S Smolen,Robert Landewé,Ferdinand C. Breedveld,Maya H Buch,Maya H Buch,Gerd R Burmester,Maxime Dougados,Paul Emery,Paul Emery,Cécile Gaujoux-Viala,Laure Gossec,Jackie L Nam,Jackie L Nam,Sofia Ramiro,Kevin L. Winthrop,Maarten de Wit,Daniel Aletaha,Neil Betteridge,Johannes W. J. Bijlsma,Maarten Boers,Frank Buttgereit,Bernard Combe,Maurizio Cutolo,Nemanja Damjanov,Johanna M. W. Hazes,Marios Kouloumas,Tore K Kvien,Xavier Mariette,Karel Pavelka,Piet L. C. M. van Riel,Andrea Rubbert-Roth,Marieke Scholte-Voshaar,David Scott,T. Sokka-Isler,John B. Wong,Désirée van der Heijde +35 more
TL;DR: These recommendations intend informing rheumatologists, patients, national rheumology societies, hospital officials, social security agencies and regulators about EULAR's most recent consensus on the management of RA, aimed at attaining best outcomes with current therapies.
EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs
Josef S Smolen,Robert Landewé,Ferdinand C. Breedveld,Maxime Dougados,Paul Emery,Cécile Gaujoux-Viala,Simone L Gorter,Rachel Knevel,Jackie L Nam,Monika Schoels,Daniel Aletaha,Maya H Buch,Laure Gossec,T.W.J. Huizinga,Johannes W. J. Bijlsma,G.-R. Burmester,B. Combe,Maurizio Cutolo,Cem Gabay,Juan J. Gomez-Reino,Marios Kouloumas,Tore K Kvien,E. Martin-Mola,Iain B. McInnes,Karel Pavelka,P.L.C.M. van Riel,M. Scholte,David Scott,T. Sokka,Guido Valesini,R. van Vollenhoven,Kevin L. Winthrop,John B. Wong,A. Zink,D. van der Heijde +34 more
TL;DR: Recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA based on evidence and expert opinion.
Journal ArticleDOI
American college of rheumatology preliminary definition of improvement in rheumatoid arthritis
David T. Felson,David T. Felson,Jennifer J. Anderson,Jennifer J. Anderson,Maarten Boers,Claire Bombardier,Claire Bombardier,Daniel E. Furst,Daniel E. Furst,Charles H. Goldsmith,Charles H. Goldsmith,Linda M. Katz,Linda M. Katz,Robert W. Lightfoot,Robert W. Lightfoot,Harold E. Paulus,Harold E. Paulus,Vibeke Strand,Vibeke Strand,Peter Tugwell,Peter Tugwell,Michael E. Weinblatt,Michael E. Weinblatt,H. James Williams,H. James Williams,Frederick Wolfe,Stephanie Kieszak +26 more
TL;DR: The results suggest that the definition of improvement presented is statistically powerful and does not identify a large percentage of placebo-treated patients as being improved, which the authors hope will be used widely in RA trials.
Journal ArticleDOI
Treating rheumatoid arthritis to target: recommendations of an international task force
Josef S Smolen,Daniel Aletaha,J. Bijlsma,Ferdinand C. Breedveld,Dimitrios T. Boumpas,Gerd R Burmester,Bernard Combe,Maurizio Cutolo,Maarten de Wit,Maxime Dougados,Paul Emery,A. Gibofsky,Juan J. Gomez-Reino,Boulos Haraoui,Joachim Kalden,Edward C. Keystone,Tore K Kvien,Iain B. McInnes,Emilio Martín-Mola,Carlomaurizio Montecucco,Monika Schoels,Désirée van der Heijde +21 more
TL;DR: The 10 recommendations are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA based on evidence and expert opinion.
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