Objectives Since the 2007 recommendations for the management of early arthritis have been presented, considerable research has been published in the field of early arthritis, mandating an update of the 2007 European League Against Rheumatism (EULAR) recommendations for management of early arthritis.
Methods In accordance with the 2014 EULAR Standardised Operating Procedures, the expert committee pursued an approach that was based on evidence in the literature and on expert opinion. The committee involved 20 rheumatologists, 2 patients and 1 healthcare professional representing 12 European countries. The group defined the focus of the expert committee and target population, formulated a definition of ‘management’ and selected the research questions. A systematic literature research (SLR) was performed by two fellows with the help of a skilled librarian. A set of draft recommendations was proposed on the basis of the research questions and the results of the SLR. For each recommendation, the categories of evidence were identified, the strength of recommendations was derived and the level of agreement was determined through a voting process.
Results The updated recommendations comprise 3 overarching principles and 12 recommendations for managing early arthritis. The selected statements involve the recognition of arthritis, referral, diagnosis, prognostication, treatment (information, education, pharmacological and non-pharmacological interventions), monitoring and strategy. Eighteen items were identified as relevant for future research.
Conclusions These recommendations provide rheumatologists, general practitioners, healthcare professionals, patients and other stakeholders with an updated EULAR consensus on the entire management of early arthritis.
- Early Rheumatoid Arthritis
- Rheumatoid Arthritis
- DMARDs (synthetic)
- Patient perspective
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Handling editor Hans WJ Bijlsma
BC and RL are joint first authors.
Contributors BC and RL wrote the first draft. CID and CH performed the systematic literature review. All authors have participated in the generation of the recommendations, have revised critically the manuscript and approved the final version.
Funding This initiative was supported by an unrestricted grant from the European League Against Rheumatism.
Competing interests All the participants in this initiative have disclosed conflict of interest. The individual declaration of conflict of interest is available on demand at the European League Against Rheumatism secretariat and is summarised below: BC has received honoraria from BMS, Janssen, Eli Lilly, Merck, Novartis, Pfizer, Roche-Chugai, Sanofi and UCB, and research grants from Pfizer, Roche-Chugai and UCB. RL has received honoraria and/or research grants from AbbVie, Ablynx, Amgen, AstraZeneca, Bristol-Myers Squibb, Celgene, Janssen, Galapagos, GlaxoSmithKline (GSK), Novartis, Novo-Nordisk, Merck, Pfizer, Roche, Schering-Plough, TiGenix, UCB. RL is director of Rheumatology Consultancy BV. CID has received honoraria from BMS, Merck, Pfizer, Roche-Chugai and UCB. DA has received honoraria from AbbVie, BMS, Centocor, Janssen, Eli Lilly, Medac, Merck, Pfizer, Roche and UCB. JMA-G has received honoraria from AbbVie, BMS, MSD, Novartis, Pfizer, Roche, Sanofi and UCB, and research grants from MSD, Pfizer, Roche and UCB. GRB has received honoraria from AbbVie, BMS, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Roche-Chugai and UCB, and research grants from Pfizer, Roche-Chugai and UCB. CC has received speaker and consulting fees from AbbVie, Amgen, Angellini, AstraZeneca, Bristol-Myers Squibb, Egis, MSD, Pfizer, Richter, Roche, Sanofi, Servier, Teva, UCB, Zentiva. RC has received honoraria from AbbVie, Roche, Pfizer and Amgen. MD has received honorarium fees for participating at advisory boards or symposia organised by Pfizer, AbbVie, UCB, Roche, Eli Lilly, Novartis, Sanofi, Merck, BMS. His department has received research grants from Pfizer, AbbVie, UCB, Roche, Eli Lilly, Novartis, Sanofi, Merck, BMS. PE has provided expert advice for AbbVie, AstraZeneca, BMS, Eli Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, Samsung, UCB. GF has received honoraria from AbbVie, Pfizer, MSD, Roche, Janssen, Eli Lilly, UCB and research grants from Roche, MSD. JF has received unrestricted research grants or acted as a speaker for AbbVie, Amgen, BMS, Biogen, Celltrion, Celgene, Hospira, Janssen, MSD, Novartis, Novo-Nordisk, Pfizer, Roche, UCB. KR has received honoraria from AbbVie, Pfizer, Roche and Janssen and research grants from AbbVie. JSS has received grants for his institution from AbbVie, Janssen, Eli Lilly, MSD, Pfizer, Roche and has provided expert advice to and/or had speaking engagements for AbbVie, Amgen, AstraZeneca, Astro, Celgene, Celltrion, GSK, ILTOO, Janssen, Eli Lilly, Medimmune, MSD, Novartis-Sandoz, Pfizer, Roche, Samsung, Sanofi, UCB. ZS has received consultant and speakers fees from AbbVie, MSD, Bristol-Myers Squibb, Roche, Pfizer. TKK has received fees for speaking and/or consulting from Biogen, BMS, Boehringer Ingelheim, Celltrion, Eli Lilly, Epirus, Hospira, Merck-Serono, Novartis, Orion Pharma, Pfizer, Sandoz and UCB. RvV has received research support and grants from AbbVie, Amgen, BMS, GSK, Pfizer, Roche, UCB, and honoraria for consultancy from AbbVie, Biotest, BMS, Celgene, Crescendo, GSK, Janssen, Eli Lilly, Merck, Novartis, Pfizer, Roche, UCB, Vertex.
Provenance and peer review Not commissioned; externally peer reviewed.
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