EXTENDED REPORT

EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

B Combe¹, R Landewe², C Lukas¹, H D Bolosiu³, F Breedveld⁴, M Dougados⁵, P Emery⁶, G Ferraccioli⁷, J M W Hazes⁸, L Klareskog⁹, K Machold¹⁰, E Martin-Mola¹¹, H Nielsen¹², A Silman¹³, J Smolen¹⁰, H Yazici¹⁴

¹ Immuno-Rhumatologie, Lapeyronie Hosp, Montpellier, France
² Rheumatic diseases, University Hosp, Maastricht, Netherlands
³ Rheumatology and Research Centre, University of Medicine, Cluj-Napoca, Romania
⁴ Rheumatology, Leiden University Medical Centre, Leiden, Netherlands
⁵ Rheumatology B, Cochin Hospital, Paris, France
⁶ Rheumatology, Academic Unit of Musculoskeletal diseases, Leeds, United Kingdom
⁷ Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
⁸ Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands
⁹ Rheumatology, Karolinska Hospital, Stockholm, Sweden
¹⁰ Internal Medicine III, Medical University, Vienna, Austria
¹¹ Rheumatology, Hospital La Paz, Madrid, Spain
¹² Rheumatology Q, University Hospital, Herlev, Denmark
¹³ ARC Unit, Manchester University, Manchester, United Kingdom
¹⁴ Rheumatology, Cerrahpasa Medical Faculty, Istanbul, Turkey

Correspondence to:
Professor Bernard Combe
Immuno-Rhumatologie, CHU Lapeyronie – 34295 Montpellier cedex 5, France; b-combe{at}chu-montpellier.fr

Objective: To formulate EULAR recommendations for the management of early arthritis.

Methods: In accordance with EULAR’s "standardised operating procedures", the task force pursued an evidence based approach and an approach based on expert opinion. A steering group comprised of 14 rheumatologists representing 10 European countries. The group defined the focus of the process, the target population, and formulated an operational definition of "management". Each participant was invited to propose issues of interest regarding the management of early arthritis or early rheumatoid arthritis. Fifteen issues for further research were selected by use of a modified Delphi technique. A systematic literature search was carried out. Evidence was categorised according to usual guidelines. A set of draft recommendations was proposed on the basis of the research questions and the results of the literature search.. The strength of the recommendations was based on the category of evidence and expert opinion.

Results: 15 research questions, covering the entire spectrum of "management of early arthritis", were formulated for further research; and 284 studies were identified and evaluated. Twelve recommendations for the management of early arthritis were selected and presented with short sentences. The selected statements included recognition of arthritis, referral, diagnosis, prognosis, classification, and treatment of early arthritis (information, education, non-pharmacological interventions, pharmacological treatments, and monitoring of the disease process). On the basis of expert opinion, 11 items were identified as being important for future research.

Conclusions: 12 key recommendations for the management of early arthritis or early rheumatoid arthritis were developed, based on evidence in the literature and expert consensus.

Abbreviations: ACR, American College of Rheumatology; ASPIRE, Active Controlled Study of Patients Receiving Infliximab for Treatment of Rheumatoid Arthritis; DAS, disease activity score; DMARD, disease modifying antirheumatic drug; ESCISIT, European Standing Committee for International Clinical Studies Including Therapeutics; EULAR, European League Against Rheumatism; RCT, randomised controlled trial; TEMPO, Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes; TICORA, Tight Control for Rheumatoid Arthritis study; TNF, tumour necrosis factor

Keywords: early arthritis; rheumatoid arthritis; management; diagnosis

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• MORVAN, J., BERTHELOT, J.-M., DEVAUCHELLE-PENSEC, V., JOUSSE-JOULIN, S., LE HENAFF-BOURHIS, C., HOANG, S., THOREL, J.-B., MARTIN, A., YOUINOU, P., SARAUX, A. (2009). Changes Over Time in the Diagnosis of Rheumatoid Arthritis in a 10-year Cohort. The Journal of Rheumatology 36: 2428-2434 [Abstract] [Full Text]  
• Funck-Brentano, T., Etchepare, F., Joulin, S. J., Gandjbakch, F., Pensec, V. D., Cyteval, C., Miquel, A., Benhamou, M., Banal, F., Le Loet, X., Cantagrel, A., Bourgeois, P., Fautrel, B. (2009). Benefits of ultrasonography in the management of early arthritis: a cross-sectional study of baseline data from the ESPOIR cohort. Rheumatology (Oxford) 0: kep279v1-kep279 [Abstract] [Full Text]  
• EMAD, Y., RAGAB, Y., SHAARAWY, A., ABOU-ZEID, A., SAAD, A., FAWZY, M., JOKHDAR, H., RASKER, J. J. (2009). Can Magnetic Resonance Imaging Differentiate Undifferentiated Arthritis Based on Knee Imaging?. The Journal of Rheumatology 36: 1963-1970 [Abstract] [Full Text]  
• BYKERK, V. (2009). Anti-Cyclic Citrullinated Peptide Antibody versus HAQ/MDHAQ: Comparing Apples and Oranges?. The Journal of Rheumatology 36: 1565-1567 [Full Text]  
• Visser, K, Katchamart, W, Loza, E, Martinez-Lopez, J A, Salliot, C, Trudeau, J, Bombardier, C, Carmona, L, van der Heijde, D, Bijlsma, J W J, Boumpas, D T, Canhao, H, Edwards, C J, Hamuryudan, V, Kvien, T K, Leeb, B F, Martin-Mola, E M, Mielants, H, Muller-Ladner, U, Murphy, G, Ostergaard, M, Pereira, I A, Ramos-Remus, C, Valentini, G, Zochling, J, Dougados, M (2009). Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. Ann Rheum Dis 68: 1086-1093 [Abstract] [Full Text]  
• Salliot, C, van der Heijde, D (2009). Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research. Ann Rheum Dis 68: 1100-1104 [Abstract] [Full Text]  
• Kiely, P. D. W., Brown, A. K., Edwards, C. J., O'Reilly, D. T., Ostor, A. J. K., Quinn, M., Taggart, A., Taylor, P. C., Wakefield, R. J., Conaghan, P. G. (2009). Contemporary treatment principles for early rheumatoid arthritis: a consensus statement. Rheumatology (Oxford) 48: 765-772 [Abstract] [Full Text]  
• HARAOUI, B. (2009). Assessment and Management of Rheumatoid Arthritis. The Journal of Rheumatology Supplement 82: 2-10 [Abstract] [Full Text]  
• HERSH, A., YAZDANY, J. (2009). Clinical Practice Guidelines and Diagnostic Uncertainty in the Management of Early Rheumatoid Arthritis. The Journal of Rheumatology 36: 863-864 [Full Text]  
• BENHAMOU, M., RINCHEVAL, N., ROY, C., FOLTZ, V., ROZENBERG, S., SIBILIA, J., SCHAEVERBEKE, T., BOURGEOIS, P., RAVAUD, P., FAUTREL, B. (2009). The Gap Between Practice and Guidelines in the Choice of First-line Disease Modifying Antirheumatic Drug in Early Rheumatoid Arthritis: Results from the ESPOIR Cohort. The Journal of Rheumatology 36: 934-942 [Abstract] [Full Text]  
• Geens, E., Geusens, P., Vanhoof, J., Berghs, H., Praet, J., Esselens, G., Lens, S., Dufour, J.-P., Vandenberghe, M., Van Mullem, X., Westhovens, R., Verschueren, P. (2009). Belgian rheumatologists' perception on eligibility of RA patients for anti-TNF treatment matches more closely Dutch rather than Belgian reimbursement criteria. Rheumatology (Oxford) 48: 546-550 [Abstract] [Full Text]  
• Emery, P, Van Vollenhoven, R, Ostergaard, M, Choy, E, Combe, B, Graninger, W, Krueger, K, Matucci-Cerinic, M, Navarro, F, van Riel, P, Settas, L, Steinfeld, S (2009). Guidelines for initiation of anti-tumour necrosis factor therapy in rheumatoid arthritis: similarities and differences across Europe. Ann Rheum Dis 68: 456-459 [Full Text]  
• Hatemi, G, Silman, A, Bang, D, Bodaghi, B, Chamberlain, A M, Gul, A, Houman, M H, Kotter, I, Olivieri, I, Salvarani, C, Sfikakis, P P, Siva, A, Stanford, M R, Stubiger, N, Yurdakul, S, Yazici, H (2008). EULAR recommendations for the management of Behcet disease. Ann Rheum Dis 67: 1656-1662 [Abstract] [Full Text]  
• Fautrel, B., Flipo, R. M., Saraux, A. (2008). Eligibility of rheumatoid arthritis patients for anti-TNF-{alpha} therapy according to the 2005 recommendations of the French and British Societies for Rheumatology. Rheumatology (Oxford) 47: 1698-1703 [Abstract] [Full Text]  
• Karonitsch, T, Aletaha, D, Boers, M, Bombardieri, S, Combe, B, Dougados, M, Emery, P, Felson, D, Gomez-Reino, J, Keystone, E, Kvien, T K, Martin-Mola, E, Matucci-Cerinic, M, Richards, P, van Riel, P, Siegel, J, Smolen, J S, Sokka, T, van der Heijde, D, van Vollenhoven, R, Ward, M, Wells, G, Zink, A, Landewe, R (2008). Methods of deriving EULAR/ACR recommendations on reporting disease activity in clinical trials of patients with rheumatoid arthritis. Ann Rheum Dis 67: 1365-1373 [Abstract] [Full Text]  
• van Tuyl, L. H. D., Plass, A. M. C., Lems, W. F., Voskuyl, A. E., Kerstens, P. J. S. M., Dijkmans, B. A. C., Boers, M. (2008). Discordant perspectives of rheumatologists and patients on COBRA combination therapy in rheumatoid arthritis. Rheumatology (Oxford) 47: 1571-1576 [Abstract] [Full Text]  
• Makinen, H, Hannonen, P, Sokka, T (2008). Sex: a major predictor of remission as measured by 28-joint Disease Activity Score (DAS28) in early rheumatoid arthritis?. Ann Rheum Dis 67: 1052-1053 [Full Text]  
• Adib, N., Hyrich, K., Thornton, J., Lunt, M., Davidson, J., Gardner-Medwin, J., Foster, H., Baildam, E., Wedderburn, L., Thomson, W. (2008). Association between duration of symptoms and severity of disease at first presentation to paediatric rheumatology: results from the Childhood Arthritis Prospective Study. Rheumatology (Oxford) 47: 991-995 [Abstract] [Full Text]  
• Choy, E H S, Smith, C M, Farewell, V, Walker, D, Hassell, A, Chau, L, Scott, D L, for the CARDERA (Combination Anti-Rheumatic Drugs, (2008). Factorial randomised controlled trial of glucocorticoids and combination disease modifying drugs in early rheumatoid arthritis. Ann Rheum Dis 67: 656-663 [Abstract] [Full Text]  
• Syversen, S W, Gaarder, P I, Goll, G L, Odegard, S, Haavardsholm, E A, Mowinckel, P, van der Heijde, D, Landewe, R, Kvien, T K (2008). High anti-cyclic citrullinated peptide levels and an algorithm of four variables predict radiographic progression in patients with rheumatoid arthritis: results from a 10-year longitudinal study. Ann Rheum Dis 67: 212-217 [Abstract] [Full Text]  
• van der Kooij, S M, Goekoop-Ruiterman, Y P M, de Vries-Bouwstra, J K, Peeters, A J, van Krugten, M V, Breedveld, F C, Dijkmans, B A C, Allaart, C F (2008). Probability of continued low disease activity in patients with recent onset rheumatoid arthritis treated according to the disease activity score. Ann Rheum Dis 67: 266-269 [Abstract] [Full Text]  
• Hyrich, K. L (2008). Patients with suspected rheumatoid arthritis should be referred early to rheumatology. BMJ 336: 215-216 [Full Text]  
• Bakker, M F, Jacobs, J W G, Verstappen, S M M, Bijlsma, J W J (2007). Tight control in the treatment of rheumatoid arthritis: efficacy and feasibility. Ann Rheum Dis 66: iii56-iii60 [Abstract] [Full Text]  
• Vliet Vlieland, T. P. M. (2007). Non-drug care for RA is the era of evidence-based practice approaching?. Rheumatology (Oxford) 46: 1397-1404 [Abstract] [Full Text]  
• Finckh, A., Liang, M. H. (2007). Anti-Cyclic Citrullinated Peptide Antibodies in the Diagnosis of Rheumatoid Arthritis: Bayes Clears the Haze. ANN INTERN MED 146: 816-817 [Full Text]  
• Scott, D. L. (2007). Early rheumatoid arthritis. Br Med Bull 0: ldm011v1-18 [Abstract] [Full Text]