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)

Bernard Combe ^1*, Robert Landewé ², Cedric Lukas ¹, Horatio D Bolosiu ³, Ferry C Breedveld ⁴, Maxime Dougados ⁵, Paul Emery ⁶, Gianfranco Ferraccioli ⁷, JMW Hazes ⁸, Lars Klareskog ⁹, Klaus Machold ¹⁰, Emilio Martin-Mola ¹¹, Henrik Nielsen ¹², Alan Silman ¹³, Josef Smolen ¹⁰ and Hasan Yazici ¹⁴

¹ Immunorhumatologie,CHU Lapeyronie,Montpellier, France
² University Hospital, Maastricht, Netherlands
³ University of Medicine ,Cluj-Napoca, Romania
⁴ University Hospital Leiden, Netherlands
⁵ Cochin Hospital,Paris, France
⁶ Academic Unitof Musculoskeletal diseases, Leeds, United Kingdom
⁷ Division of Rheumatology, Catholic University of the Sacred Heart,Roma, Italy
⁸ University Hospital Rotterdam, Netherlands
⁹ Karolinska Hospital,Stockholm, Sweden
¹⁰ Internal Medicine III,Medical University, Vienna, Austria
¹¹ Hospital Universitario La Paz,Madrid, Spain
¹² Rheumatology Q,University Hospital ,Herlev, Denmark
¹³ ARC Unit, Manchester University, United Kingdom
¹⁴ Cerrahpasa medical faculty,Istanbul, Turkey

^* To whom correspondence should be addressed. E-mail: b-combe{at}chu-montpellier.fr.

Accepted 4 January 2006

Abstract

Objectives: 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 RA. Fifteen issues for further research were selected by use of a modified Delphi technique. A systematic literature search was perfomed. 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: Fifteen research questions, covering the entire spectrum of "management of early arthritis" were formulated for further research. 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, prognostic, classification and treatment of early arthritis (information, education, nonpharmacological 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.

Conclusion: Twelve key recommendations for the management of early arthritis or early RA were developed, based on evidence in literature and expert consensus.

Keywords: DMARDs, early arthritis, management, recommendations, rheumatoid arthritis

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