Liana Fraenkel1, Joan M Bathon2, Bryant R England3, E William St Clair4, Thurayya Arayssi5, Kristine Carandang6, Kevin D Deane7, Mark Genovese8, Kent Kwas Huston9, Gail Kerr10, Joel Kremer11, Mary C Nakamura12, Linda A Russell13, Jasvinder A Singh14, Benjamin J Smith15, Jeffrey A Sparks16, Shilpa Venkatachalam17, Michael E Weinblatt16, Mounir Al-Gibbawi18, Joshua F Baker19, Kamil E Barbour20, Jennifer L Barton21, Laura Cappelli22, Fatimah Chamseddine18, Michael George23, Sindhu R Johnson24, Lara Kahale18, Basil S Karam18, Assem M Khamis18, Iris Navarro-Millán25, Reza Mirza26, Pascale Schwab21, Namrata Singh27, Marat Turgunbaev28, Amy S Turner28, Sally Yaacoub18, Elie A Akl18. 1. Berkshire Medical Center, Pittsfield, Massachusetts, and Yale University School of Medicine, New Haven, Connecticut. 2. Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York. 3. University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska. 4. Duke University Medical Center, Durham, North Carolina. 5. Weill Cornell Medicine-Qatar, Doha, Qatar. 6. University of California, San Diego. 7. University of Colorado, Aurora. 8. Stanford University Medical Center, Palo Alto, California. 9. The Center for Rheumatic Disease/Allergy and Immunology, Kansas City, Missouri. 10. Veterans Affairs Medical Center, Georgetown and Howard University, Washington, DC. 11. Albany Medical College and The Center for Rheumatology, Albany, New York. 12. University of California, San Francisco. 13. Hospital for Special Surgery, New York, New York. 14. University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama. 15. Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee. 16. Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. 17. Global Healthy Living Foundation, Upper Nyack, New York. 18. American University of Beirut, Beirut, Lebanon. 19. Corporal Michael J. Crescenz VA Medical Center and the University of Pennsylvania, Philadelphia, Pennsylvania. 20. Centers for Disease Control and Prevention, Atlanta, Georgia. 21. Oregon Health & Science University and VA Portland Health Care System, Portland, Oregon. 22. Johns Hopkins Medicine, Baltimore, Maryland. 23. University of Pennsylvania, Philadelphia. 24. Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 25. Weill Cornell Medicine, New York, New York. 26. University of Toronto, Toronto, Ontario, Canada. 27. University of Washington, Seattle. 28. American College of Rheumatology, Atlanta, Georgia.
Abstract
OBJECTIVE: To develop updated guidelines for the pharmacologic management of rheumatoid arthritis. METHODS: We developed clinically relevant population, intervention, comparator, and outcomes (PICO) questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A voting panel comprising clinicians and patients achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS: The guideline addresses treatment with disease-modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs, use of glucocorticoids, and use of DMARDs in certain high-risk populations (i.e., those with liver disease, heart failure, lymphoproliferative disorders, previous serious infections, and nontuberculous mycobacterial lung disease). The guideline includes 44 recommendations (7 strong and 37 conditional). CONCLUSION: This clinical practice guideline is intended to serve as a tool to support clinician and patient decision-making. Recommendations are not prescriptive, and individual treatment decisions should be made through a shared decision-making process based on patients' values, goals, preferences, and comorbidities.
OBJECTIVE: To develop updated guidelines for the pharmacologic management of rheumatoid arthritis. METHODS: We developed clinically relevant population, intervention, comparator, and outcomes (PICO) questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A voting panel comprising clinicians and patients achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS: The guideline addresses treatment with disease-modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs, use of glucocorticoids, and use of DMARDs in certain high-risk populations (i.e., those with liver disease, heart failure, lymphoproliferative disorders, previous serious infections, and nontuberculous mycobacterial lung disease). The guideline includes 44 recommendations (7 strong and 37 conditional). CONCLUSION: This clinical practice guideline is intended to serve as a tool to support clinician and patient decision-making. Recommendations are not prescriptive, and individual treatment decisions should be made through a shared decision-making process based on patients' values, goals, preferences, and comorbidities.
Authors: Gordon H Guyatt; Andrew D Oxman; Gunn E Vist; Regina Kunz; Yngve Falck-Ytter; Pablo Alonso-Coello; Holger J Schünemann Journal: BMJ Date: 2008-04-26
Authors: Michael D George; Joshua F Baker; Kevin Winthrop; Evo Alemao; Lang Chen; Sean Connolly; Jesse Y Hsu; Teresa A Simon; Qufei Wu; Fenglong Xie; Shuo Yang; Jeffrey R Curtis Journal: Ann Intern Med Date: 2019-05-21 Impact factor: 25.391
Authors: Sytske Anne Bergstra; Lai-Ling Winchow; Elizabeth Murphy; Arvind Chopra; Karen Salomon-Escoto; João Eurico Fonseca; Cornelia F Allaart; Robert B M Landewé Journal: Ann Rheum Dis Date: 2018-10-16 Impact factor: 19.103
Authors: Eugene S Chung; Milton Packer; Kim Hung Lo; Adedigbo A Fasanmade; James T Willerson Journal: Circulation Date: 2003-06-09 Impact factor: 29.690
Authors: Daniel P Erhardt; Grant W Cannon; Chia-Chen Teng; Ted R Mikuls; Jeffrey R Curtis; Brian C Sauer Journal: Arthritis Care Res (Hoboken) Date: 2019-08-30 Impact factor: 4.794
Authors: Louise K Mercer; Johan Askling; Pauline Raaschou; William G Dixon; Lene Dreyer; Merete Lund Hetland; Anja Strangfeld; Angela Zink; Xavier Mariette; Axel Finckh; Helena Canhao; Florenzo Iannone; Jakub Zavada; Jacques Morel; Jacques-Eric Gottenberg; Kimme L Hyrich; Joachim Listing Journal: Ann Rheum Dis Date: 2016-06-15 Impact factor: 19.103
Authors: Brian C Sauer; Chia-Chen Teng; Derek Tang; Jianwei Leng; Jeffrey R Curtis; Ted R Mikuls; David J Harrison; Grant W Cannon Journal: Arthritis Care Res (Hoboken) Date: 2017-03 Impact factor: 4.794
Authors: Pedro Santos-Moreno; Susan Martinez; Linda Ibata; Laura Villarreal; Fernando Rodríguez-Florido; Manuel Rivero; Adriana Rojas-Villarraga; Claudio Galarza-Maldonado Journal: Biologics Date: 2022-07-13
Authors: Claire E H Barber; Diane Lacaille; Ruth Croxford; Cheryl Barnabe; Deborah A Marshall; Michal Abrahamowicz; Hui Xie; J Antonio Avina-Zubieta; John M Esdaile; Glen Hazlewood; Peter Faris; Steven Katz; Paul MacMullan; Dianne Mosher; Jessica Widdifield Journal: ACR Open Rheumatol Date: 2022-05-05
Authors: Robin K Dore; Jenya N Antonova; Chakkarin Burudpakdee; Lawrence Chang; Magdaliz Gorritz; Mark C Genovese Journal: ACR Open Rheumatol Date: 2021-11-18