German guidelines for the sequential medical treatment of rheumatoid arthritis with traditional and biologic disease-modifying antirheumatic drugs

Abstract

The German Society of Rheumatology approved new German guidelines for the sequential medical treatment of rheumatoid arthritis (RA) based on the European League Against Rheumatism (EULAR) recommendations for the management of RA published in 2010. An update of the EULAR systematic literature research was performed in Medline, Embase, and Cochrane databases. Meta-analyses, controlled trials, cohort studies, and registry data addressing traditional and biologic disease-modifying antirheumatic drugs, glucocorticoids, and treatment strategies published between January 2009 and August 2011 were included. Two reviewers independently evaluated and compared the additional data that had been published after the time limit set by the EULAR recommendations. A national guideline working group developed an adapted set of recommendations. The new German guidelines were accepted by vote using an informal Delphi approach. Twelve recommendations and the resulting updated treatment algorithm were developed and approved as a practical orientation for rheumatologists. These recommendations are based on a successive treatment with traditional and biologic disease-modifying drugs depending on the individual progress of the disease and distinct patient characteristics. The German guidelines have been developed on the basis of the internationally well-recognized EULAR recommendations. In addition, more recent evidence from a systematic literature research was considered. They have been developed and approved by a group of national experts aiming at guidance for rheumatologists to reach best medical practice.

APLAR rheumatoid arthritis treatment recommendations

“…It was noted that, in every patient, treatment should be aimed at reaching a target of remission or low disease activity, as soon as possible and measuring disease activity using objective parameters such as Disease Activity Score (DAS), DAS28 (DAS of 28 joints), Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) . Consequently, this will halt joint damage, prevent disability and improve quality of life .…”

Poor prognostic factors guiding treatment decisions in rheumatoid arthritis patients: a review of data from randomized clinical trials and cohort studies

“…Moderate disease activity (DAS >3.2) + ACPA/RF positive and elevated CRP or ESR, persistence of one or more swollen joint, bone erosions on X-rays, active synovitis with power Doppler signal3. New erosionsbDMARDFrance [35]RA, DMARD failureExistence or progression of structural damage, high clinical and/or laboratory activity, high RF/ACPA titersbDMARDGermany [34]RA, 1st DMARD failureHigh disease activity, RF/ACPA positivity, early presence of joint damagebDMARDCanada [36]RANot further specifiedInitial csDMARD combination ACPA anti-citrullinated protein-peptide antibodies, ACR American College of Rheumatology, CRP C-reactive protein, ESR erythrocyte sedimentation rate, EULAR European League Against Rheumatism, DAS disease activity score, bDMARD biologic disease-modifying antirheumatic drug, csDMARD conventional synthetic disease-modifying antirheumatic drug, RA rheumatoid arthritis, RF rheumatoid factor …”

“…National recommendations are predominantly based on the international recommendations [34–37]. But several aspects regarding prognostic factors vary.…”

Towards the implementation of ‘no evidence of disease activity’ in multiple sclerosis treatment: the multiple sclerosis decision model

“…We suggest a treatment period of 6 months to reevaluate the treatment decision by assessing treatment success or failure. Such a rigorous short-term treatment optimization (after 3-6 months) has already been implemented successfully in other chronic autoimmune diseases like rheumatoid arthritis [Albrecht et al 2014]. However, in rheumatoid arthritis the disease activity and the target to treat swollen joints and pain are easier to assess than the clinical activity in patients with MS.…”