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, E, Dougados, M, Jacobs, JWG, Geenen, R, Bijlsma, JWJ, Zink, A, Aletaha, D, Schoneveld, L, van Riel, P, Dumas, S, Prior, Y ORCID:, Nikiphorou, E, Ferraccioli, G, Schett, G, Hyrich, K, Müller-Ladner, U, Buch, MH, McInnes, IB, van der Heijde, D and Van Laar, JM 2021, 'EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis' , Annals of the Rheumatic Diseases (ARD) .

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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: A 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, D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0-10: 0 completely disagree, 10 completely agree) of the PtCs were determined by the Task Force members. Results: Two overarching principles and eleven PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and nonpharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self-efficacy and the impact of comorbidities. The SoR varied from level C to D. The mean LoA with the overarching principles and PtCs was generally high (8.4-9.6). Conclusions: These points to consider 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.

Item Type: Article
Schools: Schools > School of Health and Society > Centre for Health Sciences Research
Journal or Publication Title: Annals of the Rheumatic Diseases (ARD)
Publisher: BMJ Publishing Group
ISSN: 0003-4967
Related URLs:
Funders: European Alliance of Associations for Rheumatology
Depositing User: Dr Yeliz Prior
Date Deposited: 26 Jul 2021 08:06
Last Modified: 15 Feb 2022 17:38

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