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Management of rheumatoid arthritis in China: a study of the implementation of 2019 EULAR recommendations
  1. Shangyi Jin1,
  2. Nan Jiang1,
  3. Yuehong Huo2,
  4. Xinwang Duan3,
  5. Yongfei Fang4,
  6. Cheng Zhao5,
  7. Hongbin Li6,
  8. Min Yang7,
  9. Zhirao Huang8,
  10. Pingting Yang9,
  11. Hongfeng Zhang10,
  12. Feng Zhan11,
  13. Youlian Wang12,
  14. Yanhong Wang13,
  15. Chanyuan Wu1,
  16. Qian Wang1,
  17. Evelyn Hsieh14,
  18. Mengtao Li1,
  19. Xinping Tian1,
  20. Yan Zhao1,
  21. Xiaofeng Zeng1
  1. 1 Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
  2. 2 Department of Rheumatology, The Fifth People’s Hospital of Datong, Datong, China
  3. 3 Department of Rheumatology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
  4. 4 Department of Rheumatology, Third Military Medical University, Chongqing, China
  5. 5 Department of Rheumatology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
  6. 6 Department of Rheumatology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
  7. 7 Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
  8. 8 Department of Rheumatology, Wuyuan Maternal and Child Healthcare Hospital, Jiangxi, China
  9. 9 Department of Rheumatology, The First Hospital of China Medical University, Shenyang, China
  10. 10 Department of Rheumatology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
  11. 11 Department of Rheumatology, Hainan General Hospital, Haikou, China
  12. 12 Department of Rheumatology, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
  13. 13 Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing, China
  14. 14 Section of Rheumatology, Allergy & Immunology, Yale School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Mengtao Li, Peking Union Medical College Hospital, No.1 Shuaifuyuan,Wangfujing Street, Dongcheng district, Beijing, China;{at}; Dr Xinping Tian, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng district, Beijing, China; tianxp6{at}

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Over the past few decades, several recommendations have been published to guide the management of rheumatoid arthritis (RA).1 2 However, successful implementation of these guidelines in clinical practice has lagged behind.3 In 2019, the European Alliance of Associations for Rheumatology (EULAR) published updated recommendations for the management of RA with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biological disease-modifying antirheumatic drugs (bDMARDs).1 Few studies have characterised real-world challenges to effective implementation of RA management algorithms in Asian countries. Leveraging data collected from the Chinese Registry of Rheumatoid Arthritis (CREDIT; see online supplemental materials),4 we sought to examine the degree of concordance between RA management in China and the 2019 EULAR recommendations.

Supplemental material


Patients from CREDIT were eligible for inclusion in the present study if they had newly diagnosed RA based on the 2010 American College of Rheumatology (ACR)/EULAR RA classification criteria, moderate to high disease activity (clinical disease activity index (CDAI) >10) at baseline, without severe extra-articular involvement that may affect treatment strategies. The initial treatment for a given patient was considered consistent with the EULAR recommendations if the patient initiated csDMARD monotherapy. Patients were then followed longitudinally to evaluate whether timely treatment escalation at 3 and 6 months occurred if treatment targets of remission or low disease activity were not achieved. Associations of these outcomes …

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  • Handling editor Josef S Smolen

  • SJ, NJ and YH contributed equally.

  • Collaborators We acknowledged contributions from CREDIT team all over China and the HealthCloud Co., Ltd as the system provider.

  • Contributors SJ, NJ and ML participated in the design of the study. YH, XD, YF, CZ, HL, MY, ZH, PY, HZ, FZ and YoW and other Chinese Registry of Rheumatoid Arthritis coauthors contributed to data collection. SJ, NJ, CW and YaW analysed the data. The manuscript was drafted by SJ and revised by ML, NJ, EH and QW. ML, XT, YZ and XZ supervised the study. All authors approved the final manuscript.

  • Funding This study was supported by the Chinese National Key Technology R&D Program, Ministry of Science and Technology (2017YFC0907601, 2017YFC0907604 and 2019YFC08040603),CAMS Innovation Fund for Medical Sciences (2019-I2M-2–008) and the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (2019PT330004).

  • Competing interests None declared.

  • 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.

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