German guidelines for the sequential medical treatment of rheumatoid arthritis with traditional and biologic disease-modifying antirheumatic drugs.
The German Society of Rheumatology approved new German guidelines for the sequential medical treatment of rheumatoid arthritis (RA) based on the European League Against Rheumatism (EULAR) recommendations for the management of RA published in 2010. An update of the EULAR systematic literature research was performed in Medline, Embase, and Cochrane databases. Meta-analyses, controlled trials, cohort studies, and registry data addressing traditional and biologic disease-modifying antirheumatic drugs, glucocorticoids, and treatment strategies published between January 2009 and August 2011 were included. Two reviewers independently evaluated and compared the additional data that had been published after the time limit set by the EULAR recommendations. A national guideline working group developed an adapted set of recommendations. The new German guidelines were accepted by vote using an informal Delphi approach. Twelve recommendations and the resulting updated treatment algorithm were developed and approved as a practical orientation for rheumatologists. These recommendations are based on a successive treatment with traditional and biologic disease-modifying drugs depending on the individual progress of the disease and distinct patient characteristics. The German guidelines have been developed on the basis of the internationally well-recognized EULAR recommendations. In addition, more recent evidence from a systematic literature research was considered. They have been developed and approved by a group of national experts aiming at guidance for rheumatologists to reach best medical practice.
German Society of Rheumatology, Berlin, Germany, katinka.albrecht@dgrh.de.
Katinka
K
Albrecht
Klaus
K
Krüger
Jürgen
J
Wollenhaupt
Rieke
R
Alten
Marina
M
Backhaus
Christoph
C
Baerwald
Wolfgang
W
Bolten
Jürgen
J
Braun
Harald
H
Burkhardt
Gerd R
GR
Burmester
Markus
M
Gaubitz
Angela
A
Gause
Erika
E
Gromnica-Ihle
Herbert
H
Kellner
Jens
J
Kuipers
Andreas
A
Krause
Hans-Martin
HM
Lorenz
Bernhard
B
Manger
Hubert
H
Nüßlein
Hans-Georg
HG
Pott
Andrea
A
Rubbert-Roth
Matthias
M
Schneider
Christof
C
Specker
Hendrik
H
Schulze-Koops
Hans-Peter
HP
Tony
Siegfried
S
Wassenberg
Ulf
U
Müller-Ladner
D000465:Algorithms; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D001688:Biological Products / Q000008:administration & dosage* / Q000009:adverse effects; D032921:Consensus; D019091:Critical Pathways / Q000592:standards; D003697:Delphi Technique; D004334:Drug Administration Schedule; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine / Q000592:standards; D005858:Germany; D006801:Humans; D012219:Rheumatology / Q000592:standards*; D013997:Time Factors; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D001688:Biological Products