title: Evidence-based recommendations for the diagnosis and management of rheumatoid arthritis for non-rheumatologists: Integrating systematic literature research and expert opinion of the Thai Rheumatism Association.
abstract: OBJECTIVE
  Rheumatoid arthritis (RA) is a chronic inflammatory joint disease leading to joint damage, functional disability, poor quality of life and shortened life expectancy. Early diagnosis and aggressive treatment are a principal strategy to improve outcomes. To provide best practices in the diagnosis and management of patients with RA, the Thai Rheumatism Association (TRA) developed scientifically sound and clinically relevant evidence-based recommendations for general practitioners, internists, orthopedists, and physiatrists.
  
  
  METHODS
  Thirty-seven rheumatologists from across Thailand formulated 18 clinically relevant questions: three for diagnosis, 10 for treatments, four for monitoring, and one for referral. A bibliographic team systematically reviewed the relevant literature on these topics up to December 2013. A set of recommendations was proposed based on the results of systematic reviews combined with expert opinions. Group consensus was achieved for all statements and recommendations using the nominal group technique.
  
  
  RESULTS
  A set of recommendations was proposed. For diagnosis, either American College of Rheumatology (ACR) 1987 or ACR/European League Against Rheumatism 2010 classification criteria can be applied. For treatment, nonsteroidal anti-inflammatory drugs, glucocorticoid, and disease-modifying antirheumatic drugs, including antimalarials, methotrexate and sulfasalazine are recommended. Physiotherapy should be suggested to all patients. Tight control strategy and monitoring for efficacy and side effects of treatments, as well as indications for referral to a rheumatologist are provided.
  
  
  CONCLUSIONS
  These evidence-based recommendations provide practical guidance for diagnosis, fundamental management and referral of patients with RA for non-rheumatologists. However, it should be incorporated with clinical judgments and decisions about care for each individual patient.
authors.affiliation: Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Wanruchada
authors.initials: W
authors.lastname: Katchamart
authors.affiliation: Division of Rheumatology, Department of Medicine, Pramongkutklao and College of Medicine, Bangkok, Thailand.
authors.forename: Pongthorn
authors.initials: P
authors.lastname: Narongroeknawin
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol, Bangkok, Thailand.
authors.forename: Parawee
authors.initials: P
authors.lastname: Chevaisrakul
authors.affiliation: Division of Rheumatology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
authors.forename: Pornchai
authors.initials: P
authors.lastname: Dechanuwong
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Ajanee
authors.initials: A
authors.lastname: Mahakkanukrauh
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Nuntana
authors.initials: N
authors.lastname: Kasitanon
authors.affiliation: Division of Rheumatology, Department of Medicine, Pramongkutklao and College of Medicine, Bangkok, Thailand.
authors.forename: Rattapol
authors.initials: R
authors.lastname: Pakchotanon
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Rajavithi Hospital, Bangkok, Thailand.
authors.forename: Kittiwan
authors.initials: K
authors.lastname: Sumethkul
authors.affiliation: Division of Rheumatology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand.
authors.forename: Parichat
authors.initials: P
authors.lastname: Ueareewongsa
authors.affiliation: Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Sittichai
authors.initials: S
authors.lastname: Ukritchon
authors.affiliation: Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Thitirat
authors.initials: T
authors.lastname: Bhurihirun
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Kittikorn
authors.initials: K
authors.lastname: Duangkum
authors.affiliation: Division of Rheumatology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand.
authors.forename: Porntip
authors.initials: P
authors.lastname: Intapiboon
authors.affiliation: Division of Rheumatology, Department of Medicine, Pramongkutklao and College of Medicine, Bangkok, Thailand.
authors.forename: Samanan
authors.initials: S
authors.lastname: Intongkam
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol, Bangkok, Thailand.
authors.forename: Wimol
authors.initials: W
authors.lastname: Jangsombatsiri
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Kanon
authors.initials: K
authors.lastname: Jatuworapruk
authors.affiliation: Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Naravadee
authors.initials: N
authors.lastname: Kositpesat
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol, Bangkok, Thailand.
authors.forename: Pawinee
authors.initials: P
authors.lastname: Leungroongroj
authors.affiliation: Division of Rheumatology, Department of Medicine, Pramongkutklao and College of Medicine, Bangkok, Thailand.
authors.forename: Wiyanoot
authors.initials: W
authors.lastname: Lomarat
authors.affiliation: Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Chonachan
authors.initials: C
authors.lastname: Petcharat
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Rajavithi Hospital, Bangkok, Thailand.
authors.forename: Siriluck
authors.initials: S
authors.lastname: Sittivutworapant
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Patcharawan
authors.initials: P
authors.lastname: Suebmee
authors.affiliation: Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Pongchirat
authors.initials: P
authors.lastname: Tantayakom
authors.affiliation: Division of Rheumatology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
authors.forename: Worakan
authors.initials: W
authors.lastname: Tipsing
authors.affiliation: Division of Rheumatology, Department of Medicine, Pramongkutklao and College of Medicine, Bangkok, Thailand.
authors.forename: Paijit
authors.initials: P
authors.lastname: Asavatanabodee
authors.affiliation: Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Praveena
authors.initials: P
authors.lastname: Chiowchanwisawakit
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Chingching
authors.initials: C
authors.lastname: Foocharoen
authors.affiliation: Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Ajchara
authors.initials: A
authors.lastname: Koolvisoot
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Worawit
authors.initials: W
authors.lastname: Louthrenoo
authors.affiliation: Division of Rheumatology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand.
authors.forename: Boonjing
authors.initials: B
authors.lastname: Siripaitoon
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol, Bangkok, Thailand.
authors.forename: Kitti
authors.initials: K
authors.lastname: Totemchokchyakarn
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Rajavithi Hospital, Bangkok, Thailand.
authors.forename: Tasanee
authors.initials: T
authors.lastname: Kitumnuaypong
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000628:therapy*; D032921:Consensus; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine / Q000592:standards*; D005081:Exercise Therapy / Q000592:standards; D006801:Humans; D026741:Physical Therapy Modalities / Q000592:standards; D011237:Predictive Value of Tests; D012219:Rheumatology / Q000592:standards*; D013785:Thailand; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: diagnosis; evidence-based recommendation; referral; rheumatoid arthritis; treatment