Journal article
Authors list: Nagy, Gyorgy; Roodenrijs, Nadia M. T.; Welsing, Paco M. J.; Kedves, Melinda; Hamar, Attila; van der Goes, Marlies C.; Kent, Alison; Bakkers, Margot; Pchelnikova, Polina; Blaas, Etienne; Senolt, Ladislav; Szekanecz, Zoltan; Choy, Ernest H.; Dougados, Maxime; Jacobs, Johannes W. G.; Geenen, Rinie; Bijlsma, Johannes W. J.; Zink, Angela; Aletaha, Daniel; Schoneveld, Leonard; van Riel, Piet; Dumas, Sophie; Prior, Yeliz; Nikiphorou, Elena; Ferraccioli, Gianfranco; Schett, Georg; Hyrich, Kimme L.; Mueller-Ladner, Ulf; Buch, Maya H.; McInnes, Iain B.; van der Heijde, Desiree; van Laar, Jacob M.
Publication year: 2022
Pages: 20-33
Journal: Annals of the Rheumatic Diseases
Volume number: 81
Issue number: 1
ISSN: 0003-4967
eISSN: 1468-2060
DOI Link: https://doi.org/10.1136/annrheumdis-2021-220973
Publisher: Elsevier
Abstract:
Objective To develop evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA). Methods An EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professionals. Two systematic literature reviews addressed clinical questions around diagnostic challenges, and pharmacological and non-pharmacological therapeutic strategies in D2T RA. PtCs were formulated based on the identified evidence and expert opinion. Strength of recommendations (SoR, scale A-D: A typically consistent level 1 studies and D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0-10: 0 completely disagree and 10 completely agree) of the PtCs were determined by the Task Force members. Results Two overarching principles and 11 PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and non-pharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self-efficacy and the impact of comorbidities. The SoR varied from level C to level D. The mean LoA with the overarching principles and PtCs was generally high (8.4-9.6). Conclusions These PtCs for D2T RA can serve as a clinical roadmap to support healthcare professionals and patients to deliver holistic management and more personalised pharmacological and non-pharmacological therapeutic strategies. High-quality evidence was scarce. A research agenda was created to guide future research.
Citation Styles
Harvard Citation style: Nagy, G., Roodenrijs, N., Welsing, P., Kedves, M., Hamar, A., van der Goes, M., et al. (2022) EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis, Annals of the Rheumatic Diseases, 81(1), pp. 20-33. https://doi.org/10.1136/annrheumdis-2021-220973
APA Citation style: Nagy, G., Roodenrijs, N., Welsing, P., Kedves, M., Hamar, A., van der Goes, M., Kent, A., Bakkers, M., Pchelnikova, P., Blaas, E., Senolt, L., Szekanecz, Z., Choy, E., Dougados, M., Jacobs, J., Geenen, R., Bijlsma, J., Zink, A., Aletaha, D., ...van Laar, J. (2022). EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Annals of the Rheumatic Diseases. 81(1), 20-33. https://doi.org/10.1136/annrheumdis-2021-220973
Keywords
ANTI-TNF; ANTITUMOR NECROSIS FACTOR; CLINICAL-DISEASE ACTIVITY; FIBROMYALGIA; INADEQUATE RESPONSE; JOINT PROTECTION EDUCATION; OPTICAL SPECTRAL TRANSMISSION; PATIENT EDUCATION; RANDOMIZED CONTROLLED-TRIAL; rheumatoid; SELF-MANAGEMENT; SHARED DECISION-MAKING; ultrasonography
