2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis
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John Wiley and Sons Inc
Abstract
Objective: To develop updated guidelines for the pharmacologic management of rheumatoid arthritis. Methods: We developed clinically relevant population, intervention, comparator, and outcomes (PICO) questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A voting panel comprising clinicians and patients achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. Results: The guideline addresses treatment with disease-modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs, use of glucocorticoids, and use of DMARDs in certain high-risk populations (i.e., those with liver disease, heart failure, lymphoproliferative disorders, previous serious infections, and nontuberculous mycobacterial lung disease). The guideline includes 44 recommendations (7 strong and 37 conditional). Conclusion: This clinical practice guideline is intended to serve as a tool to support clinician and patient decision-making. Recommendations are not prescriptive, and individual treatment decisions should be made through a shared decision-making process based on patients’ values, goals, preferences, and comorbidities. © 2021, American College of Rheumatology
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Antirheumatic agents, Arthritis, rheumatoid, Biological products, Drug therapy, combination, Glucocorticoids, Humans, Janus kinase inhibitors, Rheumatology, Severity of illness index, Societies, medical, Tumor necrosis factor inhibitors, United states, Abatacept, Biological product, Disease modifying antirheumatic drug, Folinic acid, Glucocorticoid, Hepatitis b core antibody, Hepatitis b surface antigen, Hydroxychloroquine, Leflunomide, Liver enzyme, Methotrexate, Rituximab, Salazosulfapyridine, Tumor necrosis factor inhibitor, Antirheumatic agent, Janus kinase inhibitor, Article, Clinical assessment, Clinical practice, Disease severity, Drug tolerability, Drug withdrawal, Grade approach, Heart failure, Hepatitis b, High risk population, Human, Immunoglobulin deficiency, Lung disease, Lymphoproliferative disease, Maximum tolerated dose, Medical literature, Monotherapy, New york heart association class, Nonalcoholic fatty liver, Patient care, Patient decision making, Patient monitoring, Persistent hypogammaglobulinemia, Pharmaceutical care, Practice guideline, Prophylaxis, Remission, Rheumatoid arthritis, Subcutaneous nodule, Titrimetry, Treatment response, Treatment switching, Virus load, Combination drug therapy, Medical society, Pathophysiology