Author:
Smolen Josef S,Landewé Robert,Breedveld Ferdinand C,Dougados Maxime,Emery Paul,Gaujoux-Viala Cecile,Gorter Simone,Knevel Rachel,Nam Jackie,Schoels Monika,Aletaha Daniel,Buch Maya,Gossec Laure,Huizinga Tom,Bijlsma Johannes W J W,Burmester Gerd,Combe Bernard,Cutolo Maurizio,Gabay Cem,Gomez-Reino Juan,Kouloumas Marios,Kvien Tore K,Martin-Mola Emilio,McInnes Iain,Pavelka Karel,van Riel Piet,Scholte Marieke,Scott David L,Sokka Tuulikki,Valesini Guido,van Vollenhoven Ronald,Winthrop Kevin L,Wong John,Zink Angela,van der Heijde Désirée
Abstract
Treatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-à-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion.
Subject
General Biochemistry, Genetics and Molecular Biology,Immunology,Immunology and Allergy,Rheumatology