Turkish League Against Rheumatism (TLAR) Recommendations for the Pharmacological Management of Rheumatoid Arthritis: 2018 Update Under Guidance of Current Recommendations

Abstract

Objectives: This study aims to report the assessment of the Turkish League Against Rheumatism (TLAR) expert panel on the compliance and adaptation of the European League Against Rheumatism (EULAR) 2016 recommendations for the management of rheumatoid arthritis (RA) in Turkey. Patients and methods: The EULAR 2016 recommendations for the treatment of RA were voted by 27 specialists experienced in this field with regard to participation rate for each recommendation and significance of items. Afterwards, each recommendation was brought forward for discussion and any alteration gaining ≥70% approval was accepted. Also, Turkish version of each item was rearranged. Last version of the recommendations was then revoted to determine the level of agreement. Levels of agreement of the two voting rounds were compared with Wilcoxon signed-rank test. In case of significant difference, the item with higher level of agreement was accepted. In case of no difference, the changed item was selected. Results: Four overarching principles and 12 recommendations were assessed among which three overarching principles and one recommendation were changed. The changed overarching principles emphasized the importance of physical medicine and rehabilitation specialists as well as rheumatologists for the care of RA patients in Turkey. An alteration was made in the eighth recommendation on treatment of active RA patients with unfavorable prognostic indicators after failure of three conventional disease modifying anti-rheumatic drugs. Remaining principles were accepted as the same although some alterations were suggested but could not find adequate support to reach significance. Conclusion: Expert opinion of the TLAR for the treatment of RA was composed for practices in Turkish rheumatology and/or physical medicine and rehabilitation clinics.

Consistency of recommendations for pharmacotherapy of rheumatoid arthritis

“…Ultimately, 26 guidelines met the criteria (see Figure 1 ). ( Lau et al, 2018 ; Smolen et al, 2020 ; Ho et al, 2019 ; Fraenkel et al, 2021 ; Cardiel et al, 2018 ; NICE, 2020 ; Peter et al, 2021 ; Fang et al, 2020 ; Alhajeri et al, 2019 ; Daien et al, 2019 ; Parisi et al, 2019 ; Leon et al, 2018 ; Ataman et al, 2018 ; Chinese Rheumatology, 2018 ; Henrique da Mota et al, 2012 ; Hurkmans et al, 2011 ; Forestier et al, 2009 ; Gossec et al, 2006 ; Jiang et al, 2018 ; Huang et al, 2011 ; Jiang, 2019-10 ; Guidelines for diagnosis and treatment of rheumatoid arthritis, 2010 ; Luo et al, 2020 ; Management of Rheumatoid Arthritis, 2019 ; Management of early rheumatoid arthritis, 2011 ; Clinical guideline for the diagnosis and management of early rheumatoid arthritis, 2009 ) Twenty-six guidelines were included in publication years ranging from 2006 to 2021. Eight CPGs were developed in China, three in France, two in the Netherlands, and one in each of the United States, Mexico, the United Kingdom, Europe, Asia Pacific, Italy, Malaysia, Brazil, Scotland, Australia, Spain, Kuwait, and Turkey.…”

Efficacy and safety of tofacitinib for immune-mediated inflammatory rheumatic diseases (Part I)

“…Расширение знаний об иммунопатогенезе ИВРЗ и роли JAK в регуляции иммунного ответа и воспаления создали предпосылки для изучения эффективности ТОФА при других ИВРЗ и «неревматических» иммуновоспалительных заболеваний [3,4,[11][12][13][14]. ТОФА классифицируется как «таргетный» синтетический базисный противовоспалительный препарат (тсБПВП) [15] и включен в международные [16][17][18][19][20][21][22][23][24][25] и российские [26] клинические рекомендации по лечению РА, а также в рекомендации Американской коллегии ревматологов (ACR) по лечению ПсА [27].…”