RT Journal Article
SR Electronic
T1 EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 20
OP 33
DO 10.1136/annrheumdis-2021-220973
VO 81
IS 1
A1 György Nagy
A1 Nadia M T Roodenrijs
A1 Paco M J Welsing
A1 Melinda Kedves
A1 Attila Hamar
A1 Marlies C van der Goes
A1 Alison Kent
A1 Margot Bakkers
A1 Polina Pchelnikova
A1 Etienne Blaas
A1 Ladislav Senolt
A1 Zoltan Szekanecz
A1 Ernest H Choy
A1 Maxime Dougados
A1 Johannes WG Jacobs
A1 Rinie Geenen
A1 Johannes WJ Bijlsma
A1 Angela Zink
A1 Daniel Aletaha
A1 Leonard Schoneveld
A1 Piet van Riel
A1 Sophie Dumas
A1 Yeliz Prior
A1 Elena Nikiphorou
A1 Gianfranco Ferraccioli
A1 Georg Schett
A1 Kimme L Hyrich
A1 Ulf Mueller-Ladner
A1 Maya H Buch
A1 Iain B McInnes
A1 Désirée van der Heijde
A1 Jacob M van Laar
YR 2022
UL http://ard.bmj.com/content/81/1/20.abstract
AB Objective To develop evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA).Methods An EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professionals. Two systematic literature reviews addressed clinical questions around diagnostic challenges, and pharmacological and non-pharmacological therapeutic strategies in D2T RA. PtCs were formulated based on the identified evidence and expert opinion. Strength of recommendations (SoR, scale A–D: A typically consistent level 1 studies and D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0–10: 0 completely disagree and 10 completely agree) of the PtCs were determined by the Task Force members.Results Two overarching principles and 11 PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and non-pharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self-efficacy and the impact of comorbidities. The SoR varied from level C to level D. The mean LoA with the overarching principles and PtCs was generally high (8.4–9.6).Conclusions These PtCs for D2T RA can serve as a clinical roadmap to support healthcare professionals and patients to deliver holistic management and more personalised pharmacological and non-pharmacological therapeutic strategies. High-quality evidence was scarce. A research agenda was created to guide future research.