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EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update

Authors :
Smolen, Josef S.
Landewe, Robert
Bijlsma, Johannes
Burmester, Gerd
Chatzidionysiou, Katerina
Dougados, Maxime
Nam, Jackie
Ramiro, Sofia
Voshaar, Marieke
van Vollenhoven, Ronald
Aletaha, Daniel
Aringer, Martin
Boers, Maarten
Buckley, Chris D.
Buttgereit, Frank
Bykerk, Vivian
Cardiel, Mario
Combe, Bernard
Cutolo, Maurizio
van Eijk-Hustings, Yvonne
Emery, Paul
Finckh, Axel
Gabay, Cem
Gomez-Reino, Juan
Gossec, Laure
Gottenberg, Jacques-Eric
Hazes, Johanna M. W.
Huizinga, Tom
Jani, Meghna
Karateev, Dmitry
Kouloumas, Marios
Kvien, Tore
Li, Zhanguo
Mariette, Xavier
McInnes, Iain
Mysler, Eduardo
Nash, Peter
Pavelka, Karel
Poor, Gyula
Richez, Christophe
van Riel, Piet
Rubbert-Roth, Andrea
Saag, Kenneth
da Silva, Jose
Stamm, Tanja
Takeuchi, Tsutomu
Westhovens, Rene
de Wit, Maarten
van der Heijde, Desiree
Smolen, Josef S.
Landewe, Robert
Bijlsma, Johannes
Burmester, Gerd
Chatzidionysiou, Katerina
Dougados, Maxime
Nam, Jackie
Ramiro, Sofia
Voshaar, Marieke
van Vollenhoven, Ronald
Aletaha, Daniel
Aringer, Martin
Boers, Maarten
Buckley, Chris D.
Buttgereit, Frank
Bykerk, Vivian
Cardiel, Mario
Combe, Bernard
Cutolo, Maurizio
van Eijk-Hustings, Yvonne
Emery, Paul
Finckh, Axel
Gabay, Cem
Gomez-Reino, Juan
Gossec, Laure
Gottenberg, Jacques-Eric
Hazes, Johanna M. W.
Huizinga, Tom
Jani, Meghna
Karateev, Dmitry
Kouloumas, Marios
Kvien, Tore
Li, Zhanguo
Mariette, Xavier
McInnes, Iain
Mysler, Eduardo
Nash, Peter
Pavelka, Karel
Poor, Gyula
Richez, Christophe
van Riel, Piet
Rubbert-Roth, Andrea
Saag, Kenneth
da Silva, Jose
Stamm, Tanja
Takeuchi, Tsutomu
Westhovens, Rene
de Wit, Maarten
van der Heijde, Desiree
Publication Year :
2017

Abstract

Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recommendations address conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GC); biological (b) DMARDs (tumour necrosis factor (TNF)-inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, clazakizumab, sarilumab and sirukumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (Janus kinase (Jak) inhibitors tofacitinib, baricitinib). Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. Cost aspects were taken into consideration. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at >50% improvement within 3 and target attainment within 6 months. If this fails stratification is recommended. Without unfavourable prognostic markers, switching to-or adding-another csDMARDs (plus short-term GC) is suggested. In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered. For each recommendation, levels of evidence and Task Force agreement are provided, both mostly very high. These recommendations intend informing rheumatologists, patients, national rheumatolog

Details

Database :
OAIster
Notes :
English
Publication Type :
Electronic Resource
Accession number :
edsoai.on1364918148
Document Type :
Electronic Resource