title: EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs.
abstract: 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.
authors.affiliation: Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. josef.smolen@wienkav.at
authors.forename: Josef S
authors.initials: JS
authors.lastname: Smolen
authors.forename: Robert
authors.initials: R
authors.lastname: Landewé
authors.forename: Ferdinand C
authors.initials: FC
authors.lastname: Breedveld
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
authors.forename: Cecile
authors.initials: C
authors.lastname: Gaujoux-Viala
authors.forename: Simone
authors.initials: S
authors.lastname: Gorter
authors.forename: Rachel
authors.initials: R
authors.lastname: Knevel
authors.forename: Jackie
authors.initials: J
authors.lastname: Nam
authors.forename: Monika
authors.initials: M
authors.lastname: Schoels
authors.forename: Daniel
authors.initials: D
authors.lastname: Aletaha
authors.forename: Maya
authors.initials: M
authors.lastname: Buch
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
authors.forename: Tom
authors.initials: T
authors.lastname: Huizinga
authors.forename: Johannes W J W
authors.initials: JW
authors.lastname: Bijlsma
authors.forename: Gerd
authors.initials: G
authors.lastname: Burmester
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cutolo
authors.forename: Cem
authors.initials: C
authors.lastname: Gabay
authors.forename: Juan
authors.initials: J
authors.lastname: Gomez-Reino
authors.forename: Marios
authors.initials: M
authors.lastname: Kouloumas
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.forename: Emilio
authors.initials: E
authors.lastname: Martin-Mola
authors.forename: Iain
authors.initials: I
authors.lastname: McInnes
authors.forename: Karel
authors.initials: K
authors.lastname: Pavelka
authors.forename: Piet
authors.initials: P
authors.lastname: van Riel
authors.forename: Marieke
authors.initials: M
authors.lastname: Scholte
authors.forename: David L
authors.initials: DL
authors.lastname: Scott
authors.forename: Tuulikki
authors.initials: T
authors.lastname: Sokka
authors.forename: Guido
authors.initials: G
authors.lastname: Valesini
authors.forename: Ronald
authors.initials: R
authors.lastname: van Vollenhoven
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Winthrop
authors.forename: John
authors.initials: J
authors.lastname: Wong
authors.forename: Angela
authors.initials: A
authors.lastname: Zink
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
mesh_terms: 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
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha
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