RT Journal Article
SR Electronic
T1 Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 3
OP 15
DO 10.1136/annrheumdis-2015-207524
VO 75
IS 1
A1 Smolen, Josef S
A1 Breedveld, Ferdinand C
A1 Burmester, Gerd R
A1 Bykerk, Vivian
A1 Dougados, Maxime
A1 Emery, Paul
A1 Kvien, Tore K
A1 Navarro-Compán, M Victoria
A1 Oliver, Susan
A1 Schoels, Monika
A1 Scholte-Voshaar, Marieke
A1 Stamm, Tanja
A1 Stoffer, Michaela
A1 Takeuchi, Tsutomu
A1 Aletaha, Daniel
A1 Andreu, Jose Louis
A1 Aringer, Martin
A1 Bergman, Martin
A1 Betteridge, Neil
A1 Bijlsma, Hans
A1 Burkhardt, Harald
A1 Cardiel, Mario
A1 Combe, Bernard
A1 Durez, Patrick
A1 Fonseca, Joao Eurico
A1 Gibofsky, Alan
A1 Gomez-Reino, Juan J
A1 Graninger, Winfried
A1 Hannonen, Pekka
A1 Haraoui, Boulos
A1 Kouloumas, Marios
A1 Landewe, Robert
A1 Martin-Mola, Emilio
A1 Nash, Peter
A1 Ostergaard, Mikkel
A1 Östör, Andrew
A1 Richards, Pam
A1 Sokka-Isler, Tuulikki
A1 Thorne, Carter
A1 Tzioufas, Athanasios G
A1 van Vollenhoven, Ronald
A1 de Wit, Martinus
A1 van der Heijde, Desirée
YR 2016
UL http://ard.bmj.com/content/75/1/3.abstract
AB Background Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights.Objective To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion.Methods A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived.Results The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1–3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (≥9/10).Conclusions The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.