Doporučení EULAR pro léčbu revmatoidní artritidy - rozdíly mezi verzí 2013 a 2010.

European League against Rheumatism (EULAR) has appointed a committee of experts (the so called Task Force), which published a new version of the EULAR recommendations for the treatment of rheumatoid arthritis (RA). Methodology: The recommended methodology for the creation of all official EULAR recommendations was applied. After the appointment of the committee a EULAR general methodology, used in production of official EULAR recommendations, was applied. A literature review of all English-language publications from the years 2009--2012 was performed, which supplemented the original evidence from 2010. Every quality randomized, controlled clinical trial published as a full-text article or an abstract from EULAR congresses 2012--2013 was included. Based on evidence, the individual recommendations were proposed and subsequently underwent a total of 5 rounds of the so-called Delphi method. Finally, three overarching principles and a total of 14 recommendations were defined. Results: The major differences between the new and the old recommendations include: achieving a low activity or remission at 6 months, however, achieving at least response to treatment with csDMARDs after 3 months; initiation of MTX therapy either as a monotherapy or in combination with more csDMARDs (MTX + SAS + HCQ); more emphasis on the application of glucocorticoids in early RA in combination with MTX (csDMARDs), however, limited to six months of application; anti-TNF inhibitors, abatacept, tocilizumab, and rituximab in certain circumstances are recommended after failure of MTX as the first biological drug; biosimilars are listed as an alternative -- to date, biosimilar infliximab has already been approved; tofacitinib is mentioned, which may be applied only after failure of at least one anti-TNF drug. Recently, EMA has refused its registration. [ABSTRACT FROM AUTHOR]