EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis

Nagy G, Roodenrijs NMT, Welsing PMJ, Kedves M, Hamar A, Van Der Goes MC, Kent A, Bakkers M, Pchelnikova P, Blaas E, Senolt L, Szekanecz Z, Choy EH, Dougados M, Jacobs JWG, Geenen R, Bijlsma JWJ, Zink A, Aletaha D, Schoneveld L, Van Riel P, Dumas S, Prior Y, Nikiphorou E, Ferraccioli G, Schett G, Hyrich KL, Mueller-Ladner U, Buch MH, Mcinnes IB, Van Der Heijde D, Van Laar JM (2021)

Publication Type: Journal article

Publication year: 2021

Journal

DOI: 10.1136/annrheumdis-2021-220973

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.

Authors with CRIS profile

Involved external institutions

Semmelweis University / Semmelweis Egyetem Hungary (HU) Universiteit Utrecht (UU) / Utrecht University Netherlands (NL) Bács-Kiskun Megyei Kórház Hungary (HU) University of Debrecen / Debreceni Egyetem Hungary (HU) Salisbury District Hospital United Kingdom (GB) European League Against Rheumatism (EULAR) Switzerland (CH) Univerzita Karlova v Praze / Charles University in Prague Czech Republic (CZ) Cardiff University United Kingdom (GB) University of Paris 4 - Paris-Sorbonne / Université paris IV Paris-Sorbonne France (FR) Deutsches Rheuma-Forschungszentrum (DRFZ) Germany (DE) Medizinische Universität Wien Austria (AT) Bravis Hospital Netherlands (NL) Radboud University Nijmegen Netherlands (NL) Hôpital Marin de Hendaye / Marin Hendaye Hospital France (FR) University of Salford United Kingdom (GB) King’s College London United Kingdom (GB) Catholic University of the Sacred Heart / Università Cattolica del Sacro Cuore Italy (IT) Manchester University NHS Foundation Trust (MFT) United Kingdom (GB) Justus-Liebig-Universität Gießen Germany (DE) University of Glasgow United Kingdom (GB) Leiden University Netherlands (NL)

How to cite

APA:

Nagy, G., Roodenrijs, N.M.T., Welsing, P.M.J., Kedves, M., Hamar, A., Van Der Goes, M.C.,... Van Laar, J.M. (2021). EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Annals of the Rheumatic Diseases. https://doi.org/10.1136/annrheumdis-2021-220973

MLA:

Nagy, Gyorgy, et al. "EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis." Annals of the Rheumatic Diseases (2021).

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