2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis

Arthritis Care and Research - Tập 73 Số 7 - Trang 924-939 - 2021
Liana Fraenkel1, Joan M. Bathon2, Bryant R. England3, E. William St. Clair4, Thurayya Arayssi5, Kristine Carandang6, Kevin D. Deane7, Mark C. Genovese8, K. Huston9, Gail S. Kerr10, Joel M. Kremer11, Mary C. Nakamura12, Linda A. Russell13, Jasvinder A. Singh14, Benjamin J. Smith15, Jeffrey A. Sparks16, Shilpa Venkatachalam17, Michael E. Weinblatt16, Mounir Al‐Gibbawi18, Joshua F. Baker19, Kamil E. Barbour20, Jennifer L. Barton21, Laura C. Cappelli22, Fatimah Chamseddine18, Michael George23, Sindhu R. Johnson24, Lara A Kahale18, Basil S. Karam18, Assem M. Khamis18, Iris Navarro‐Millán25, Reza Mirza26, Pascale Schwab21, Namrata Singh27, Marat Turgunbaev28, Amy S. Turner28, Sally Yaacoub18, Elie A. Akl18
1Berkshire Medical Center, Pittsfield, Massachusetts, and Yale University School of Medicine, New Haven, Connecticut
2Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York
3University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska
4Duke University Medical Center, Durham, North Carolina
5Weill Cornell Medicine – Qatar Doha, Qatar
6University of California, San Diego
7University of Colorado, Aurora
8Stanford University Medical Center, Palo Alto, California
9The Center for Rheumatic Disease/Allergy and Immunology, Kansas City, Missouri
10Veterans Affairs Medical Center, Georgetown and Howard University, Washington, DC
11Albany Medical College and The Center for Rheumatology, Albany, New York
12University of California San Francisco
13Hospital for Special Surgery, New York, New York
14University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
15Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee
16Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
17Global Healthy Living Foundation, Upper Nyack, New York
18American University of Beirut, Beirut, Lebanon
19Corporal Michael J. Crescenz VA Medical Center and the University of Pennsylvania, Philadelphia, Pennsylvania
20Centers for Disease Control and Prevention, Atlanta, Georgia
21Oregon Health & Science University and VA Portland Health Care System Portland Oregon
22Johns Hopkins Medicine, Baltimore, Maryland
23University of Pennsylvania, Philadelphia
24Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
25Weill Cornell Medicine, New York, New York
26University of Toronto, Toronto, Ontario, Canada
27University of Washington, Seattle
28American College of Rheumatology Atlanta Georgia

Tóm tắt

ObjectiveTo develop updated guidelines for the pharmacologic management of rheumatoid arthritis.MethodsWe 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.ResultsThe 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).ConclusionThis 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.

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Arthritis Care and Research

Tập 73 Số 7

924-939

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