Article Text

2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis
  1. Elena Nikiphorou1,2,
  2. Eduardo José Ferreira Santos3,4,
  3. Andrea Marques3,4,
  4. Peter Böhm5,
  5. Johannes WJ Bijlsma6,
  6. Claire Immediato Daien7,
  7. Bente Appel Esbensen8,9,
  8. Ricardo J O Ferreira3,4,
  9. George E Fragoulis10,
  10. Pat Holmes11,
  11. Hayley McBain12,
  12. George S Metsios13,14,
  13. Rikke Helene Moe15,
  14. Tanja A Stamm16,
  15. Annette de Thurah17,18,
  16. Condruta Zabalan19,
  17. Loreto Carmona20,
  18. Ailsa Bosworth21
  1. 1 Rheumatology Department, King's College Hospital, London, UK
  2. 2 Centre for Rheumatic Diseases, King’s College London, London, UK
  3. 3 Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
  4. 4 Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal
  5. 5 German League against Rheumatism, Bonn, Germany
  6. 6 Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  7. 7 Lapeyronie Hospital, CHU Montpellier, and Inserm U1046, CNRS UMR 9214, Montpellier University, Montpellier, France
  8. 8 Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Denmark
  9. 9 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  10. 10 First Department of Internal Medicine, Propaedeutic Clinic, Athens, Greece
  11. 11 National Rheumatoid Arthritis Society, Maidenhead, UK
  12. 12 School of Health Sciences, City, University of London, London, UK
  13. 13 Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall, UK
  14. 14 Department of Nutrition and Dietetics, University of Thessaly, Trikala, Thessaly, Greece
  15. 15 Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
  16. 16 Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
  17. 17 Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
  18. 18 Departent of Clinical Medicine, Aarhus University, Aarhus, Denmark
  19. 19 Romanian League against Rheumatism, Bucharest, Romania
  20. 20 Instituto de Salud Musculoesquelética, Madrid, Spain
  21. 21 National Rheumatoid Arthritis Society, Littlewick Green, UK
  1. Correspondence to Dr Elena Nikiphorou, Rheumatology Department, King's College London, London SE5 9RJ, UK; enikiphorou{at}


Background An important but often insufficient aspect of care in people with inflammatory arthritis (IA) is empowering patients to acquire a good understanding of their disease and building their ability to deal effectively with the practical, physical and psychological impacts of it. Self-management skills can be helpful in this regard.

Objectives To develop recommendations for the implementation of self-management strategies in IA.

Methods A multidisciplinary taskforce of 18 members from 11 European countries was convened. A systematic review and other supportive information (survey of healthcare professionals (HCPs) and patient organisations) were used to formulate the recommendations.

Results Three overarching principles and nine recommendations were formulated. These focused on empowering patients to become active partners of the team and to take a more proactive role. The importance of patient education and key self-management interventions such as problem solving, goal setting and cognitive behavioural therapy were highlighted. Role of patient organisations and HCPs in promoting and signposting patients to available resources has been highlighted through the promotion of physical activity, lifestyle advice, support with mental health aspects and ability to remain at work. Digital healthcare is essential in supporting and optimising self-management and the HCPs need to be aware of available resources to signpost patients.

Conclusion These recommendations support the inclusion of self-management advice and resources in the routine management of people with IA and aim to empower and support patients and encourage a more holistic, patient-centred approach to care which could result in improved patient experience of care and outcomes.

  • arthritis
  • rheumatoid
  • outcome assessment
  • health care
  • psoriatic
  • spondylitis
  • ankylosing

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  • LC and AB are joint senior authors.

  • Handling editor Dimitrios T Boumpas

  • Twitter @ElenaNikiUK, @FerreiraRJO, @FragoulisGeorge, @GeorgeMetsios, @carmona_loreto

  • EJFS and AM contributed equally.

  • Correction notice This article has been corrected since it published Online First. The ORCID ID for Rikke Helene Moe has been added and author's name amended.

  • Contributors All authors are members of European Alliance of Associations for Rheumatology’s (EULAR) task force for the development of 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis. All authors have contributed to the work and read and approved the final manuscript for submission. EJFS, AM, LC and AB have joint positions.

  • Funding This project has received funding by the European League Against Rheumatism, Project number: PAR028.

  • Competing interests EN reports personal fees and other from AbbVie, Eli-Lilly, Gilead, Celltrion and Pfizer and other from Sanofi, outside the submitted work. JWJB reports personal fees from Roche, Lilly and Galapagos, outside the submitted work. CID reports personal fees and other from AbbVie, Abivax, BMS, Fresenius, Galapagos, Lilly, Pfizer, Roche-Chugaï and Sanofi, outside the submitted work. BAE has received speaking fees from Pfizer and Eli Lilly. RJOF reports personal fees from Sanofi and UCB, outside the submitted work. GEF reports honoraria from UCB and Aenorasis, outside the submitted work. TAS has received grant/research support from AbbVie and Roche, has been consultant for AbbVie and Sanofi Genzyme and has been a paid speaker for AbbVie, Roche, Sanofi and Takeda. EJFS, AM, PB, PH, HM, GSM, RHM, AdT, CZ, LC and AB report no conflicts of interest.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.