2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis Academic Article uri icon

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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.

authors

  • Fraenkel, Liana
  • Bathon, Joan M
  • England, Bryant R
  • St.Clair, E William
  • Arayssi, Thurayya
  • Carandang, Kristine
  • Deane, Kevin D
  • Genovese, Mark
  • Huston, Kent Kwas
  • Kerr, Gail
  • Kremer, Joel
  • Nakamura, Mary C
  • Russell, Linda A
  • Singh, Jasvinder A
  • Smith, Benjamin J
  • Sparks, Jeffrey A
  • Venkatachalam, Shilpa
  • Weinblatt, Michael E
  • Al‐Gibbawi, Mounir
  • Baker, Joshua F
  • Barbour, Kamil E
  • Barton, Jennifer L
  • Cappelli, Laura
  • Chamseddine, Fatimah
  • George, Michael
  • Johnson, Sindhu R
  • Kahale, Lara
  • Karam, Basil S
  • Khamis, Assem M
  • Navarro-Millán, Iris
  • Mirza, Reza
  • Schwab, Pascale
  • Singh, Namrata
  • Turgunbaev, Marat
  • Turner, Amy S
  • Yaacoub, Sally
  • Akl, Elie

publication date

  • July 2021