Canadian Rheumatology Association Recommendations for Pharmacological Management of Rheumatoid Arthritis with Traditional and Biologic Disease-modifying Antirheumatic Drugs

Bykerk, Vivian P.; Akhavan, Pooneh; Hazlewood, Glen; Schieir, Orit; Dooley, Anne; Haraoui, Boulos; Khraishi, Majed; LeClercq, Sharon; Légaré, France; Mosher, Diane P; Pencharz, James; Pope, Janet; Thomson, John; Thorne, Carter; Zummer, Michel; Bombardier, Claire

doi:10.3899/jrheum.110207

Cited by 262 publications

(291 citation statements)

References 75 publications

(214 reference statements)

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“…Guidelines, quality standards, and quality indicators recommend that RA patients be seen at least yearly in followup to evaluate their disease status, screen for comorbidities, and review medications 5, 7, 28, 29. There has unfortunately been little published evaluation on RA patients who may have gaps in care or get lost to followup and on the consequences of lack of rheumatologist care.…”

Section: Discussionmentioning

confidence: 99%

High Adherence to System‐Level Performance Measures for Rheumatoid Arthritis in a National Early Arthritis Cohort Over Eight Years

Barber

Schieir

Lacaille

et al. 2018

Arthritis Care & Research

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ObjectiveTo assess adherence to 3 system‐level performance measures in a national early rheumatoid arthritis (RA) cohort.MethodsPatients enrolled in the Canadian Early Arthritis Cohort (2007–2015) who met 1987 or 2010 American College of Rheumatology/European League Against Rheumatism criteria with <1 year of symptom duration and ≥1 year of followup after enrollment were included. Performance measures assessed were the percentage of RA patients seen in yearly followup, and the number of gaps between visits of >12 or >14 months, the percentage of RA patients treated with a disease‐modifying antirheumatic drug (DMARD), and days from RA diagnosis to initiation of a DMARD. Results are shown stratified by enrollment year to assess for temporal changes in performance.ResultsA total of 1,763 early RA patients were included (mean age 54 years, 73% female, and 82% white). At enrollment, mean ± SD disease duration was 6 ± 3 months, and Disease Activity Score in 28 joints was 5.1 ± 1.5. Over 8 years, the proportion of patients seen in annual followup declined from 100% to 91%. Over followup, 42% of patients had 0 gaps in care of >12 months, and 64% had 0 gaps >14 months. The percentage of DMARD‐treated early RA patients was and remained high (95–87%), and the percentage receiving DMARDs within 14 days of diagnosis was 75%. Median time‐to‐DMARD therapy was 1 day, indicating DMARDs were initiated at diagnosis (90th percentile 93 days).ConclusionThere was evidence of high adherence to system‐level performance measures in this early RA cohort following a protocol. Small declines in performance were noted with increasing length of patient followup. Our findings are useful for performance measure benchmarking.

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Section: Discussionmentioning

confidence: 99%

High Adherence to System‐Level Performance Measures for Rheumatoid Arthritis in a National Early Arthritis Cohort Over Eight Years

Barber

Schieir

Lacaille

et al. 2018

Arthritis Care & Research

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“…Evidence reports for each of the 5 candidate items were conducted and reviewed by the CRA Choosing Wisely Methodology subcommittee, key opinion leaders, CRA Board of Directors, and 3 patient members of the Canadian Arthritis Patient Alliance. We used a modified system developed by the Scottish Intercollegiate Guideline Network to grade evidence 9 . A Supplementary Table (Online Supplementary Data 1, available online at jrheum.org) shows the custom system for assigning levels of evidence and strength of recommendations.…”

Section: Methodsmentioning

confidence: 99%

Choosing Wisely: The Canadian Rheumatology Association’s List of 5 Items Physicians and Patients Should Question

Sl¹,

J²,

Mj³

et al. 2015

J Rheumatol

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Objective.To develop a list of 5 tests or treatments used in rheumatology that have evidence indicating that they may be unnecessary and thus should be reevaluated by rheumatology healthcare providers and patients.Methods.Using the Delphi method, a committee of 16 rheumatologists from across Canada and an allied health professional generated a list of tests, procedures, or treatments in rheumatology that may be unnecessary, nonspecific, or insensitive. Items with high content agreement and perceived relevance advanced to a survey of Canadian Rheumatology Association (CRA) members. CRA members ranked these top items based on content agreement, effect, and item ranking. A methodology subcommittee discussed the items in light of their relevance to rheumatology, potential effect on patients, and the member survey results. Five candidate items selected were then subjected to a literature review. A group of patient collaborators with rheumatic diseases also reviewed these items.Results.Sixty-four unique items were proposed and after 3 Delphi rounds, this list was narrowed down to 13 items. In the member-wide survey, 172 rheumatologists responded (36% of those contacted). The respondent characteristics were similar to the membership at large in terms of sex and geographical distribution. Five topics (antinuclear antibodies testing, HLA-B27 testing, bone density testing, bone scans, and bisphosphonate use) with high ratings on agreement and effect were chosen for literature review.Conclusion.The list of 5 items has identified starting points to promote discussion about practices that should be questioned to assist rheumatology healthcare providers in delivering high-quality care.

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“…Develop trial designs that better reflect the patients who will receive the products (reflected in current guidelines 5,6 ), and good clinical practice (GCP). Regulators play a significant role in shaping industry drug development programs; they must consider and encourage alternative study designs, outcomes, and endpoints through education from regional experts.…”

Section: Rheumatologymentioning

confidence: 99%

Arthritis Clinical Trials at a Crossroad

et al. 2015

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Canadian Rheumatology Association Recommendations for Pharmacological Management of Rheumatoid Arthritis with Traditional and Biologic Disease-modifying Antirheumatic Drugs

Abstract: These recommendations were developed based on a synthesis of international guidelines, supporting evidence, and expert consensus considering the Canadian healthcare context with the intention of promoting best practices and improving healthcare delivery for persons with RA.

Cited by 262 publications

References 75 publications

High Adherence to System‐Level Performance Measures for Rheumatoid Arthritis in a National Early Arthritis Cohort Over Eight Years

High Adherence to System‐Level Performance Measures for Rheumatoid Arthritis in a National Early Arthritis Cohort Over Eight Years

Choosing Wisely: The Canadian Rheumatology Association’s List of 5 Items Physicians and Patients Should Question

Arthritis Clinical Trials at a Crossroad

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