EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis

Nagy, György, Roodenrijs, Nadia M T, Welsing, Paco M J, Kedves, Melinda, Hamar, Attila, van der Goes, Marlies C, Kent, Alison, Bakkers, Margot, Pchelnikova, Polina, Blaas, Etienne, Senolt, Ladislav, Szekanecz, Zoltan, Choy, Ernest H ORCID: https://orcid.org/0000-0003-4459-8609, Dougados, Maxime, Jacobs, Johannes WG, Geenen, Rinie, Bijlsma, Johannes WJ, Zink, Angela, Aletaha, Daniel, Schoneveld, Leonard, van Riel, Piet, Dumas, Sophie, Prior, Yeliz, Nikiphorou, Elena, Ferraccioli, Gianfranco, Schett, Georg, Hyrich, Kimme L, Mueller-Ladner, Ulf, Buch, Maya H, McInnes, Iain B, van der Heijde, Désirée and van Laar, Jacob M 2022. EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Annals of the Rheumatic Diseases 81 (1) , pp. 20-33. 10.1136/annrheumdis-2021-220973

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Abstract

Objective To develop evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA). Methods An EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professionals. Two systematic literature reviews addressed clinical questions around diagnostic challenges, and pharmacological and non-pharmacological therapeutic strategies in D2T RA. PtCs were formulated based on the identified evidence and expert opinion. Strength of recommendations (SoR, scale A–D: A typically consistent level 1 studies and D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0–10: 0 completely disagree and 10 completely agree) of the PtCs were determined by the Task Force members. Results Two overarching principles and 11 PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and non-pharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self-efficacy and the impact of comorbidities. The SoR varied from level C to level D. The mean LoA with the overarching principles and PtCs was generally high (8.4–9.6). Conclusions These PtCs for D2T RA can serve as a clinical roadmap to support healthcare professionals and patients to deliver holistic management and more personalised pharmacological and non-pharmacological therapeutic strategies. High-quality evidence was scarce. A research agenda was created to guide future research.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0)
Publisher:	BMJ Publishing Group
ISSN:	0003-4967
Date of First Compliant Deposit:	26 January 2022
Date of Acceptance:	23 July 2021
Last Modified:	03 May 2023 21:49
URI:	https://orca.cardiff.ac.uk/id/eprint/146970

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