C Fiehn1,2, J Holle3,4, C Iking-Konert3,5, J Leipe3,6, C Weseloh3, M Frerix3,7, R Alten3,8, F Behrens3,9,10, C Baerwald3,11, J Braun3,12, H Burkhardt3,9,10, G Burmester3,13, J Detert3,13, M Gaubitz3,14, A Gause3,15, E Gromnica-Ihle16, H Kellner3,17,18, A Krause3,19, J Kuipers3,20, H-M Lorenz3,21,22, U Müller-Ladner3,7, M Nothacker23, H Nüsslein3,24, A Rubbert-Roth3,25, M Schneider3,26, H Schulze-Koops3,6, S Seitz27,28, H Sitter23, C Specker3,29, H-P Tony3,30, S Wassenberg3,31, J Wollenhaupt3,32, K Krüger3,33. 1. Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Deutschland. c.fiehn@rheuma-badenbaden.de. 2. Praxis für Rheumatologie, Tätigkeitsschwerpunkt Klinische Immunologie und Belegarzteinheit der ViDia-Kliniken Karlsruhe am Medical Center Baden-Baden, Beethovenstr. 2, 76530, Baden-Baden, Deutschland. c.fiehn@rheuma-badenbaden.de. 3. Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Deutschland. 4. Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland. 5. Klinik für Nephrologie und Rheumatologie, Med. Klinik III, Universitätsklinik, Hamburg Eppendorf (UKE), Hamburg, Deutschland. 6. Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, München, Deutschland. 7. Abteilung für Rheumatologie und Klinische Immunologie, Campus Kerckhoff, Justus-Liebig-Universität Gießen, Bad Nauheim, Deutschland. 8. Abteilung Innere Medizin II, Rheumatologie, Klinische Immunologie, Osteologie, Schlosspark-Klinik, Charité - Universitätsmedizin Berlin, Berlin, Deutschland. 9. Abteilung Rheumatologie, Universitätsklinikum Frankfurt am Main, Goethe Universität Frankfurt am Main, Frankfurt am Main, Deutschland. 10. Fraunhofer Institut IME, Translationale Medizin und Pharmakologie, Frankfurt am Main, Deutschland. 11. Sektion Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland. 12. Rheumazentrum Ruhrgebiet, Herne, Deutschland. 13. Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM), Berlin, Deutschland. 14. Akademie für Manuelle Therapie an der WWU Münster, Münster, Deutschland. 15. Rheumapraxis Bad Bramstedt, Bad Bramstedt, Deutschland. 16. Deutsche Rheuma-Liga Bundesverband e. V., Bonn, Deutschland. 17. Schwerpunktpraxis für Rheumatologie und Gastroenterologie, München, Deutschland. 18. Abteilung Rheumatologie, Krankenhaus Neuwittelsbach, München, Deutschland. 19. Klinik für Rheumatologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland. 20. Klinik für internistische Rheumatologie, Rotes Kreuz Krankenhaus Bremen gGmbH, Bremen, Deutschland. 21. Medizinische Universitätsklinik V: Hämatologie, Onkologie, Rheumatologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland. 22. ACURA Rheumazentrum Baden-Baden, Baden-Baden, Deutschland. 23. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. (AWMF), Berlin, Deutschland. 24. Rheumatologische Schwerpunktpraxis, Nürnberg, Deutschland. 25. Klinik für Rheumatologie, Kantonsspital St. Gallen, St. Gallen, Schweiz. 26. Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Heinrich-Heine Universität Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland. 27. Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie e. V. (DGOOC) und Deutsche Gesellschaft für Orthopädische Rheumatologie (DGORh), Hamburg, Deutschland. 28. Klinik für Orthopädie, Klinikum Hochsauerland, Marienhospital, Arnsberg, Deutschland. 29. Klinik für Rheumatologie und klinische Immunologie, St. Josef Krankenhaus Essen-Werden, Universitätsmedizin Essen, Essen, Deutschland. 30. Abteilung für Rheumatologie und klinische Immunologie, Zentrum für Innere Medizin, Universitätsklinikum Würzburg, Würzburg, Deutschland. 31. Rheumazentrum Ratingen, Ratingen, Deutschland. 32. Rheumatologikum Hamburg, Hamburg, Deutschland. 33. Rheumatologisches Praxiszentrum, München, Deutschland.
Abstract
BACKGROUND: Medication-based strategies to treat rheumatoid arthritis are crucial in terms of outcome. They aim at preventing joint destruction, loss of function and disability by early and consistent inhibition of inflammatory processes. OBJECTIVE: Achieving consensus about evidence-based recommendations for the treatment of rheumatoid arthritis with disease-modifying anti-rheumatic drugs in Germany. METHODS: Following a systematic literature research, a structured process among expert rheumatologists was used to reach consensus. RESULTS: The results of the consensus process can be summed up in 6 overarching principles and 10 recommendations. There are several new issues compared to the version of 2012, such as differentiated adjustments to the therapeutic regime according to time point and extent of treatment response, the therapeutic goal of achieving remission as assessed by means of the simplified disease activity index (SDAI) as well as the potential use of targeted synthetic DMARDs (JAK inhibitors) and suggestions for a deescalating in case of achieving a sustained remission. Methotrexate still plays the central role at the beginning of the treatment and as a combination partner in the further treatment course. When treatment response to methotrexate is inadequate, either switching to or combining with another conventional synthetic DMARD is an option in the absence of unfavourable prognostic factors. Otherwise biologic or targeted synthetic DMARDs are recommended according to the algorithm. Rules for deescalating treatment with glucocorticoids and-where applicable-DMARDs give support for the management of patients who have reached a sustained remission. DISCUSSION: The new guidelines set up recommendations for RA treatment in accordance with the treat-to-target principle. Modern disease-modifying drugs, now including also JAK inhibitors, are available in an algorithm.
BACKGROUND: Medication-based strategies to treat rheumatoid arthritis are crucial in terms of outcome. They aim at preventing joint destruction, loss of function and disability by early and consistent inhibition of inflammatory processes. OBJECTIVE: Achieving consensus about evidence-based recommendations for the treatment of rheumatoid arthritis with disease-modifying anti-rheumatic drugs in Germany. METHODS: Following a systematic literature research, a structured process among expert rheumatologists was used to reach consensus. RESULTS: The results of the consensus process can be summed up in 6 overarching principles and 10 recommendations. There are several new issues compared to the version of 2012, such as differentiated adjustments to the therapeutic regime according to time point and extent of treatment response, the therapeutic goal of achieving remission as assessed by means of the simplified disease activity index (SDAI) as well as the potential use of targeted synthetic DMARDs (JAK inhibitors) and suggestions for a deescalating in case of achieving a sustained remission. Methotrexate still plays the central role at the beginning of the treatment and as a combination partner in the further treatment course. When treatment response to methotrexate is inadequate, either switching to or combining with another conventional synthetic DMARD is an option in the absence of unfavourable prognostic factors. Otherwise biologic or targeted synthetic DMARDs are recommended according to the algorithm. Rules for deescalating treatment with glucocorticoids and-where applicable-DMARDs give support for the management of patients who have reached a sustained remission. DISCUSSION: The new guidelines set up recommendations for RA treatment in accordance with the treat-to-target principle. Modern disease-modifying drugs, now including also JAK inhibitors, are available in an algorithm.
Authors: Daniel Aletaha; Tuhina Neogi; Alan J Silman; Julia Funovits; David T Felson; Clifton O Bingham; Neal S Birnbaum; Gerd R Burmester; Vivian P Bykerk; Marc D Cohen; Bernard Combe; Karen H Costenbader; Maxime Dougados; Paul Emery; Gianfranco Ferraccioli; Johanna M W Hazes; Kathryn Hobbs; Tom W J Huizinga; Arthur Kavanaugh; Jonathan Kay; Tore K Kvien; Timothy Laing; Philip Mease; Henri A Ménard; Larry W Moreland; Raymond L Naden; Theodore Pincus; Josef S Smolen; Ewa Stanislawska-Biernat; Deborah Symmons; Paul P Tak; Katherine S Upchurch; Jirí Vencovsky; Frederick Wolfe; Gillian Hawker Journal: Ann Rheum Dis Date: 2010-09 Impact factor: 19.103
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Authors: Michaela A Stoffer; Monika M Schoels; Josef S Smolen; Daniel Aletaha; Ferdinand C Breedveld; Gerd Burmester; Vivian Bykerk; Maxime Dougados; Paul Emery; Boulos Haraoui; Juan Gomez-Reino; Tore K Kvien; Peter Nash; Victoria Navarro-Compán; Marieke Scholte-Voshaar; Ronald van Vollenhoven; Désirée van der Heijde; Tanja A Stamm Journal: Ann Rheum Dis Date: 2015-05-19 Impact factor: 19.103
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