Work

Updated recommendations for the treatment of rheumatoid arthritis: Another step on a long road

Year: 2012

Type: editorial

Abstract: The development of targeted biologic therapy for rheumatoid arthritis (RA) has revolutionized treatment of this chronic disease and provided clinicians with a diverse menu of options for improving disease control, limiting radiographic progression of joint damage, and enhancing physical function.However, many fundamental questions about the optimal treatment of RA remain unanswered.What is the best initial DMARD therapy for patients with recent onset RA?What is the most effective treatment strategy for reducing long term damage?When should partially effective therapy be changed?How can the risks of drug therapy be mitigated for the individual patient?It is also difficult to translate our knowledge about the efficacy and safety of different therapies to the individual patient.Without validated biomarkers of treatment response, decision-making lacks a probability framework for predicting efficacy and toxicity at a 'personalized' level.For this reason, treatment decisions are guided by clinical intuition in the 'real world' despite being solidly grounded in a body of scientific evidence.In this issue of Arthritis Care and Research, J. Singh and colleagues have taken the most current evidence from clinical studies to update the recommendations for the use of diseasemodifying anti-rheumatic drugs (DMARDs) and biologics in RA (1).The last set of ACR recommendations for the treatment of RA was published in 2008 (2).In the short span of the past 4 years, the playing field has changed with the approval of new biologics and the publication of additional clinical information about the existing agents.The 2012 recommendations reflect a synthesis of the best available evidence in providing rheumatologists with an update on the important topic of RA treatment.The investigators updated the 2012 recommendations using the same methodology as the 2008 recommendations.This approach utilized a Core Expert Panel (CEP) and a Task Force Panel (TFP), including an updated systematic review of the scientific literature.The CEP, which was comprised of individuals with clinical and methodologic RA-related expertise, was charged with developing clinical scenarios to address specific treatment issues.These scenarios were then rated by the TFP, a body of internationally recognized expert clinicians, methodologists in evidence-based medicine, and patient representatives.The ratings by the TFP were based on the updated evidence report and scored using the RAND/UCLA Appropriateness method (3).The treatment scenarios were then re-rated after extensive in

Source: Arthritis Care & Research

DOI: 10.1002/acr.21659

Authors: David I. Daikh, E. William St.Clair

Institutions: San Francisco VA Medical Center, University of California, San Francisco, Duke University, Duke Medical Center

Language: English

Topic: Rheumatoid Arthritis Research and Therapies

Subfield: Rheumatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

Funders: National Institutes of Health, National Institute of Allergy and Infectious Diseases