title: Canadian Rheumatology Association recommendations for pharmacological management of rheumatoid arthritis with traditional and biologic disease-modifying antirheumatic drugs.
abstract: OBJECTIVE
  The Canadian Rheumatology Association (CRA) has developed recommendations for the pharmacological management of rheumatoid arthritis (RA) with traditional and biologic disease-modifying antirheumatic drugs (DMARD) in 2 parts. Part 1 is reported here.
  
  
  METHODS
  The CRA Therapeutics Committee assembled a national working group of RA clinical experts, researchers, patient consumers, and a general practitioner. Treatment questions were developed a priori based on results of a national needs assessment survey. A systematic review of all clinical practice guidelines and consensus statements regarding treatment with traditional and biologic DMARD in patients with RA published between January 2000 and June 2010 was performed in Medline, Embase, and CINAHL databases, and the grey literature. Guideline quality was assessed by 2 independent reviewers, and guideline characteristics, recommendations, and supporting evidence from observational studies and randomized controlled trials were synthesized into evidence tables. The full working group reviewed the evidence tables and developed recommendations using a modified Delphi technique.
  
  
  RESULTS
  Five overarching principles and 26 recommendations addressing general RA management strategies and treatment with glucocorticoids and traditional and biologic DMARD were developed for rheumatologists, other primary prescribers of RA drug therapies, and patients with RA.
  
  
  CONCLUSIONS
  These recommendations were developed based on a synthesis of international guidelines, supporting evidence, and expert consensus considering the Canadian healthcare context with the intention of promoting best practices and improving healthcare delivery for persons with RA.
authors.affiliation: Mount Sinai Hospital, The Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Toronto, Canada. vbykerk@mtsinai.on.ca
authors.forename: Vivian P
authors.initials: VP
authors.lastname: Bykerk
authors.forename: Pooneh
authors.initials: P
authors.lastname: Akhavan
authors.forename: Glen S
authors.initials: GS
authors.lastname: Hazlewood
authors.forename: Orit
authors.initials: O
authors.lastname: Schieir
authors.forename: Anne
authors.initials: A
authors.lastname: Dooley
authors.forename: Boulos
authors.initials: B
authors.lastname: Haraoui
authors.forename: Majed
authors.initials: M
authors.lastname: Khraishi
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Leclercq
authors.forename: Jean
authors.initials: J
authors.lastname: Légaré
authors.forename: Diane P
authors.initials: DP
authors.lastname: Mosher
authors.forename: James
authors.initials: J
authors.lastname: Pencharz
authors.forename: Janet E
authors.initials: JE
authors.lastname: Pope
authors.forename: John
authors.initials: J
authors.lastname: Thomson
authors.forename: Carter
authors.initials: C
authors.lastname: Thorne
authors.forename: Michel
authors.initials: M
authors.lastname: Zummer
authors.forename: Claire
authors.initials: C
authors.lastname: Bombardier
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002170:Canada; D032921:Consensus; D019317:Evidence-Based Medicine; D006801:Humans
chemical_list: D018501:Antirheumatic Agents