2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis

Abstract

Objective To develop a new evidence‐based, pharmacologic treatment guideline for rheumatoid arthritis (RA). Methods We conducted systematic reviews to synthesize the evidence for the benefits and harms of various treatment options. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence. We employed a group consensus process to grade the strength of recommendations (either strong or conditional). A strong recommendation indicates that clinicians are certain that the benefits of an intervention far outweigh the harms (or vice versa). A conditional recommendation denotes uncertainty over the balance of benefits and harms and/or more significant variability in patient values and preferences. Results The guideline covers the use of traditional disease‐modifying antirheumatic drugs (DMARDs), biologic agents, tofacitinib, and glucocorticoids in early (<6 months) and established (≥6 months) RA. In addition, it provides recommendations on using a treat‐to‐target approach, tapering and discontinuing medications, and the use of biologic agents and DMARDs in patients with hepatitis, congestive heart failure, malignancy, and serious infections. The guideline addresses the use of vaccines in patients starting/receiving DMARDs or biologic agents, screening for tuberculosis in patients starting/receiving biologic agents or tofacitinib, and laboratory monitoring for traditional DMARDs. The guideline includes 74 recommendations: 23% are strong and 77% are conditional. Conclusion This RA guideline should serve as a tool for clinicians and patients (our two target audiences) for pharmacologic treatment decisions in commonly encountered clinical situations. These recommendations are not prescriptive, and the treatment decisions should be made by physicians and patients through a shared decision‐making process taking into account patients’ values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

Factors influencing the choice of first- and second-line biologic therapy for the treatment of rheumatoid arthritis: real-life data from the Italian LORHEN Registry

“…However, it is generally accepted that switching from a second to a third TNFi is associated with significantly lower response to treatment and a different MoA should be considered in these patients [8]. Only scant and cautious acknowledgement of potential differences in the safety profile of available bDMARDs comes from the 2015 American College of Rheumatology (ACR) guideline for the treatment of RA [9] that indicates ABA, noteworthy with a very low level of evidence, as the drug of choice in case of previous serious infections and ABA or TCZ over TNFis in patients with a previous lymphoproliferative disorder.…”

Rheumatoid Arthritis Therapy and Joint-replacement Surgery: Are We Making a Difference?

“…Others have also reported that age at the time of disease onset affects choice of therapy and that seniors receive less aggressive therapy 16 , despite the striking concordance that optimal therapy in RA includes DMARD therapy as soon as the diagnosis of RA is made 17 . Improving the outcome of patients with RA is an ongoing effort, and goals now include a decreased need for major surgery such as arthroplasty.…”

Critical Review on Ellumnishadi Lepa: An Ayurvedic Topical Applicant in Knee Joint Swellings Associated With Rheumatoid Arthritis

“…RA has a significant negative impact on the ability to perform daily activities, including work and household tasks, health related quality of life and it increases mortality. 1 . Earliest possible diagnosis and treatment with disease modifying anti rheumatic agents (DMARD) to limit the degree of irreversible joint damage are recommended by conventional science in the management of RA.…”