EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs.
Treatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-à-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These 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.
Smolen
Josef S
JS
Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. josef.smolen@wienkav.at
Landewé
Robert
R
Breedveld
Ferdinand C
FC
Dougados
Maxime
M
Emery
Paul
P
Gaujoux-Viala
Cecile
C
Gorter
Simone
S
Knevel
Rachel
R
Nam
Jackie
J
Schoels
Monika
M
Aletaha
Daniel
D
Buch
Maya
M
Gossec
Laure
L
Huizinga
Tom
T
Bijlsma
Johannes W J W
JW
Burmester
Gerd
G
Combe
Bernard
B
Cutolo
Maurizio
M
Gabay
Cem
C
Gomez-Reino
Juan
J
Kouloumas
Marios
M
Kvien
Tore K
TK
Martin-Mola
Emilio
E
McInnes
Iain
I
Pavelka
Karel
K
van Riel
Piet
P
Scholte
Marieke
M
Scott
David L
DL
Sokka
Tuulikki
T
Valesini
Guido
G
van Vollenhoven
Ronald
R
Winthrop
Kevin L
KL
Wong
John
J
Zink
Angela
A
van der Heijde
Désirée
D
D000465:Algorithms; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine / Q000379:methods; D005938:Glucocorticoids / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D018501:Antirheumatic Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha
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