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

György Nagy; Nadia M T Roodenrijs; Paco M J Welsing; Melinda Kedves; Attila Hamar; Marlies C van der Goes; Alison Kent; Margot Bakkers; Polina Pchelnikova; Etienne Blaas; Ladislav Senolt; Zoltan Szekanecz; Ernest H Choy; Maxime Dougados; Johannes Wg Jacobs; Rinie Geenen; Johannes Wj Bijlsma; Angela Zink; Daniel Aletaha; Leonard Schoneveld; Piet van Riel; Sophie Dumas; Yeliz Prior; Elena Nikiphorou; Gianfranco Ferraccioli; Georg Schett; Kimme L Hyrich; Ulf Mueller-Ladner; Maya H Buch; Iain B McInnes; Désirée van der Heijde; Jacob M van Laar

doi:10.1136/annrheumdis-2021-220973

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

György Nagy, Nadia M T Roodenrijs, Paco M J Welsing, Melinda Kedves, Attila Hamar, Marlies C van der Goes, Alison Kent, Margot Bakkers, Polina Pchelnikova, Etienne Blaas, Ladislav Senolt, Zoltan Szekanecz, Ernest H Choy, Maxime Dougados, Johannes Wg Jacobs, Rinie Geenen, Johannes Wj Bijlsma, Angela Zink, Daniel Aletaha, Leonard SchoneveldPiet van Riel, Sophie Dumas, Yeliz Prior, Elena Nikiphorou, Gianfranco Ferraccioli, Georg Schett, Kimme L Hyrich, Ulf Mueller-Ladner, Maya H Buch, Iain B McInnes, Désirée van der Heijde, Jacob M van Laar

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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.

Original language	English
Pages (from-to)	20-33
Number of pages	14
Journal	Annals of the Rheumatic Diseases
Volume	81
Issue number	1
Early online date	18 Aug 2021
DOIs	https://doi.org/10.1136/annrheumdis-2021-220973
Publication status	Published - 1 Jan 2022

Keywords

arthritis
fibromyalgia
inflammation
rheumatoid
ultrasonography

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Nagy, G., Roodenrijs, N. M. T., Welsing, P. M. J., Kedves, M., Hamar, A., van der Goes, M. C., Kent, A., Bakkers, M., Pchelnikova, P., Blaas, E., Senolt, L., Szekanecz, Z., Choy, E. H., Dougados, M., Jacobs, J. W., Geenen, R., Bijlsma, J. W., Zink, A., Aletaha, D., ... van Laar, J. M. (2022). EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Annals of the Rheumatic Diseases, 81(1), 20-33. https://doi.org/10.1136/annrheumdis-2021-220973

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title = "EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis",

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.",

keywords = "arthritis, fibromyalgia, inflammation, rheumatoid, ultrasonography",

author = "Gy{\"o}rgy Nagy and Roodenrijs, {Nadia M T} and Welsing, {Paco M J} and Melinda Kedves and Attila Hamar and {van der Goes}, {Marlies C} and Alison Kent and Margot Bakkers and Polina Pchelnikova and Etienne Blaas and Ladislav Senolt and Zoltan Szekanecz and Choy, {Ernest H} and Maxime Dougados and Jacobs, {Johannes Wg} and Rinie Geenen and Bijlsma, {Johannes Wj} and Angela Zink and Daniel Aletaha and Leonard Schoneveld and {van Riel}, Piet and Sophie Dumas and Yeliz Prior and Elena Nikiphorou and Gianfranco Ferraccioli and Georg Schett and Hyrich, {Kimme L} and Ulf Mueller-Ladner and Buch, {Maya H} and McInnes, {Iain B} and {van der Heijde}, D{\'e}sir{\'e}e and {van Laar}, {Jacob M}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2022",

year = "2022",

month = jan,

day = "1",

doi = "10.1136/annrheumdis-2021-220973",

language = "English",

volume = "81",

pages = "20--33",

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Nagy, G, Roodenrijs, NMT, Welsing, PMJ, Kedves, M, Hamar, A, van der Goes, MC, Kent, A, Bakkers, M, Pchelnikova, P, Blaas, E, Senolt, L, Szekanecz, Z, Choy, EH, Dougados, M, Jacobs, JW, Geenen, R, Bijlsma, JW, Zink, A, Aletaha, D, Schoneveld, L, van Riel, P, Dumas, S, Prior, Y, Nikiphorou, E, Ferraccioli, G, Schett, G, Hyrich, KL, Mueller-Ladner, U, Buch, MH, McInnes, IB, van der Heijde, D & van Laar, JM 2022, 'EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis', Annals of the Rheumatic Diseases, vol. 81, no. 1, pp. 20-33. https://doi.org/10.1136/annrheumdis-2021-220973

TY - JOUR

T1 - EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis

AU - Nagy, György

AU - Roodenrijs, Nadia M T

AU - Welsing, Paco M J

AU - Kedves, Melinda

AU - Hamar, Attila

AU - van der Goes, Marlies C

AU - Kent, Alison

AU - Bakkers, Margot

AU - Pchelnikova, Polina

AU - Blaas, Etienne

AU - Senolt, Ladislav

AU - Szekanecz, Zoltan

AU - Choy, Ernest H

AU - Dougados, Maxime

AU - Jacobs, Johannes Wg

AU - Geenen, Rinie

AU - Bijlsma, Johannes Wj

AU - Zink, Angela

AU - Aletaha, Daniel

AU - Schoneveld, Leonard

AU - van Riel, Piet

AU - Dumas, Sophie

AU - Prior, Yeliz

AU - Nikiphorou, Elena

AU - Ferraccioli, Gianfranco

AU - Schett, Georg

AU - Hyrich, Kimme L

AU - Mueller-Ladner, Ulf

AU - Buch, Maya H

AU - McInnes, Iain B

AU - van der Heijde, Désirée

AU - van Laar, Jacob M

PY - 2022/1/1

Y1 - 2022/1/1

N2 - 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.

AB - 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.

KW - arthritis

KW - fibromyalgia

KW - inflammation

KW - rheumatoid

KW - ultrasonography

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U2 - 10.1136/annrheumdis-2021-220973

DO - 10.1136/annrheumdis-2021-220973

M3 - Article

C2 - 34407926

SN - 0003-4967

VL - 81

SP - 20

EP - 33

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 1

ER -

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

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