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

Autor:	Nagy G; Department of Rheumatology & Clinical Immunology, Semmelweis University, Budapest, Hungary nagy.gyorgy2@med.semmelweis-univ.hu.; Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary., Roodenrijs NMT; Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Welsing PMJ; Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Kedves M; Bács-Kiskun County Hospital, Rheumatology Department, Kecskemét, Hungary., Hamar A; Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary., van der Goes MC; Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.; Department of Rheumatology, Meander Medical Center, Amersfoort, The Netherlands., Kent A; Salisbury Foundation Trust NHS Hospital, Wiltshire, UK., Bakkers M; EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland., Pchelnikova P; EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland., Blaas E; Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Senolt L; Department of Rheumatology, 1st Faculty of Medicine, Charles University and Institute of Rheumatology, Prague, Czech Republic., Szekanecz Z; Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary., Choy EH; CREATE Centre, Section of Rheumatology, School of Medicine, Division of Infection and Immunity, Cardiff University, Cardiff, UK., Dougados M; Université de Paris Department of Rheumatology - Hôpital Cochin. Assistance Publique - Hôpitaux de Paris INSERM (U1153) Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France., Jacobs JW; Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Geenen R; Department of Psychology, Utrecht University, Utrecht, The Netherlands., Bijlsma JW; Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Zink A; Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany., Aletaha D; Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria., Schoneveld L; Department of Rheumatology, Bravis Hospital, Roosendaal, The Netherlands., van Riel P; Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands., Dumas S; Department of Pharmacy, Marin Hospital, Asisstance Publique-Hopitaux de Paris, Hendaye, France., Prior Y; School of Health and Society, Centre for Health Sciences Research, University of Salford, Salford, UK., Nikiphorou E; Centre for Rheumatic Diseases, King's College London, London, UK.; Rheumatology Department, King's College Hospital, London, UK., Ferraccioli G; School of Medicine, Catholic University of the Sacred Heart, Rome, Italy., Schett G; Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg and Universitatsklinikum Erlangen, Erlangen, Germany., Hyrich KL; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.; Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK., Mueller-Ladner U; Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Bad Nauheim, Germany., Buch MH; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.; Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.; Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK., McInnes IB; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK., van der Heijde D; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands., van Laar JM; Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Jazyk:	angličtina
Zdroj:	Annals of the rheumatic diseases [Ann Rheum Dis] 2022 Jan; Vol. 81 (1), pp. 20-33. Date of Electronic Publication: 2021 Aug 18.
DOI:	10.1136/annrheumdis-2021-220973
Abstrakt:	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. Competing Interests: Competing interests: Participants provided declaration of interest, the individual declarations will be attached as online supplemental file. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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