TY - JOUR
T1 - 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis
AU - Fraenkel, Liana
AU - Bathon, Joan M.
AU - England, Bryant R.
AU - St.Clair, E. William
AU - Arayssi, Thurayya
AU - Carandang, Kristine
AU - Deane, Kevin D.
AU - Genovese, Mark
AU - Huston, Kent Kwas
AU - Kerr, Gail
AU - Kremer, Joel
AU - Nakamura, Mary C.
AU - Russell, Linda A.
AU - Singh, Jasvinder A.
AU - Smith, Benjamin J.
AU - Sparks, Jeffrey A.
AU - Venkatachalam, Shilpa
AU - Weinblatt, Michael E.
AU - Al-Gibbawi, Mounir
AU - Baker, Joshua F.
AU - Barbour, Kamil E.
AU - Barton, Jennifer L.
AU - Cappelli, Laura
AU - Chamseddine, Fatimah
AU - George, Michael
AU - Johnson, Sindhu R.
AU - Kahale, Lara
AU - Karam, Basil S.
AU - Khamis, Assem M.
AU - Navarro-Millán, Iris
AU - Mirza, Reza
AU - Schwab, Pascale
AU - Singh, Namrata
AU - Turgunbaev, Marat
AU - Turner, Amy S.
AU - Yaacoub, Sally
AU - Akl, Elie A.
N1 - Funding Information:
We thank Stanley B. Cohen, MD, for his contributions during the scoping phase of the project. We thank Cassandra Calabrese, DO, Leonard Calabrese, DO, Joseph Lim, MD, Danielle Antin-Ozerkis, MD, Marcus R. Pereira, MD, MPH, Jason E. Stout, MD, MHS, and Kevin Winthrop, MD, MPH, for their expert input as the voting panel considered recommendations related to comorbidities. We thank Nancy Baker, ScD, MPH, OTR/I, and Daniel White, PT, ScD, MSc, for their contributions during the scoping phase of the project, as well as their input during early deliberations by the voting panel. We thank the patients who (along with authors Kristine Carandang, PhD, OTR/L, and Shilpa Venkatachalam, PhD) participated in the patient panel meeting: Susan Campbell, Rachelle Crow-Hercher, MEd, Doug Davis, Sidney Harper, Faith Powell, Zenethia Roberts, Mary Turner, and C. Whitney White, PharmD. We thank the ACR staff, including Regina Parker for assistance in organizing the face-to-face meeting and coordinating the administrative aspects of the project, Robin Lane for assistance in manuscript preparation, and Jocelyn Givens for assistance with recruitment for the patient panel. We thank Janet Waters and Janet Joyce for their assistance in developing the literature search strategy, as well as performing the initial literature search and update searches. Author Genovese was employed by Stanford University Medical Center during development of this guideline but at the time of publication will also be employed by Gilead Sciences. Gilead Sciences had no financial or other interest in this project, had no input in the design, content, data collection, or analysis, and had no role in the writing or approval of this article.
Publisher Copyright:
© 2021, American College of Rheumatology
PY - 2021/7
Y1 - 2021/7
N2 - 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.
AB - 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.
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U2 - 10.1002/acr.24596
DO - 10.1002/acr.24596
M3 - Article
C2 - 34101387
AN - SCOPUS:85107805071
SN - 2151-464X
VL - 73
SP - 924
EP - 939
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 7
ER -