2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.

Abstract

OBJECTIVE:

To develop updated guidelines for the pharmacologic management of rheumatoid arthritis.

METHODS:

We developed clinically relevant population, intervention, comparator, and outcomes (PICO) questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A voting panel comprising clinicians and patients achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.

RESULTS:

The guideline addresses treatment with disease-modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs, use of glucocorticoids, and use of DMARDs in certain high-risk populations (i.e., those with liver disease, heart failure, lymphoproliferative disorders, previous serious infections, and nontuberculous mycobacterial lung disease). The guideline includes 44 recommendations (7 strong and 37 conditional).

CONCLUSION:

This clinical practice guideline is intended to serve as a tool to support clinician and patient decision-making. Recommendations are not prescriptive, and individual treatment decisions should be made through a shared decision-making process based on patients' values, goals, preferences, and comorbidities.

• Authors: Liana Fraenkel, Joan M Bathon, Bryant R England, E William St Clair, Thurayya Arayssi, Kristine Carandang, Kevin D Deane, Mark Genovese, Kent Kwas Huston, Gail Kerr, Joel Kremer, Mary C Nakamura, Linda A Russell, Jasvinder A Singh, Benjamin J Smith, Jeffrey A Sparks, Shilpa Venkatachalam, Michael E Weinblatt, Mounir Al-Gibbawi, Joshua F Baker, Kamil E Barbour, Jennifer L Barton, Laura Cappelli, Fatimah Chamseddine, Michael George, Sindhu R Johnson, Lara Kahale, Basil S Karam, Assem M Khamis, Iris Navarro-Millán, Reza Mirza, Pascale Schwab, Namrata Singh, Marat Turgunbaev, Amy S Turner, Sally Yaacoub, Elie A Akl
• Journal: Arthritis & rheumatology (Hoboken, N.J.) (Arthritis Rheumatol) Vol. 73 Issue 7 Pg. 1108-1123 (07 2021) ISSN: 2326-5205 [Electronic] United States
• PMID: 34101376 (Publication Type: Journal Article, Practice Guideline, Research Support, Non-U.S. Gov't, Systematic Review)
• Copyright: © 2021, American College of Rheumatology.

Chemical References

• Antirheumatic Agents
• Biological Products
• Glucocorticoids
• Janus Kinase Inhibitors
• Tumor Necrosis Factor Inhibitors

Topics

• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (drug therapy, physiopathology)
• Biological Products (therapeutic use)
• Drug Therapy, Combination
• Glucocorticoids (therapeutic use)
• Humans
• Janus Kinase Inhibitors (therapeutic use)
• Rheumatology
• Severity of Illness Index
• Societies, Medical
• Tumor Necrosis Factor Inhibitors (therapeutic use)
• United States