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

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

doi:10.1002/art.41752

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

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 BakerKamil 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

Research output: Contribution to journal › Article › peer-review

443 Scopus citations

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.

Original language	English (US)
Pages (from-to)	1108-1123
Number of pages	16
Journal	Arthritis & rheumatology (Hoboken, N.J.)
Volume	73
Issue number	7
DOIs	https://doi.org/10.1002/art.41752
State	Published - Jul 2021

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10.1002/art.41752

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Fraenkel, L., Bathon, J. M., England, B. R., St Clair, E. W., Arayssi, T., Carandang, K., Deane, K. D., Genovese, M., Huston, K. K., Kerr, G., Kremer, J., Nakamura, M. C., Russell, L. A., Singh, J. A., Smith, B. J., Sparks, J. A., Venkatachalam, S., Weinblatt, M. E., Al-Gibbawi, M., ... Akl, E. A. (2021). 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis & rheumatology (Hoboken, N.J.), 73(7), 1108-1123. https://doi.org/10.1002/art.41752

Fraenkel, L, Bathon, JM, England, BR, St Clair, EW, Arayssi, T, Carandang, K, Deane, KD, Genovese, M, Huston, KK, Kerr, G, Kremer, J, Nakamura, MC, Russell, LA, Singh, JA, Smith, BJ, Sparks, JA, Venkatachalam, S, Weinblatt, ME, Al-Gibbawi, M, Baker, JF, Barbour, KE, Barton, JL, Cappelli, L, Chamseddine, F, George, M, Johnson, SR, Kahale, L, Karam, BS, Khamis, AM, Navarro-Millán, I, Mirza, R, Schwab, P, Singh, N, Turgunbaev, M, Turner, AS, Yaacoub, S & Akl, EA 2021, '2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis', Arthritis & rheumatology (Hoboken, N.J.), vol. 73, no. 7, pp. 1108-1123. https://doi.org/10.1002/art.41752

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title = "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.",

author = "Liana Fraenkel and Bathon, {Joan M} and England, {Bryant R} and {St Clair}, {E William} and Thurayya Arayssi and Kristine Carandang and Deane, {Kevin D} and Mark Genovese and Huston, {Kent Kwas} and Gail Kerr and Joel Kremer and Nakamura, {Mary C} and Russell, {Linda A} and Singh, {Jasvinder A} and Smith, {Benjamin J} and Sparks, {Jeffrey A} and Shilpa Venkatachalam and Weinblatt, {Michael E} and Mounir Al-Gibbawi and Baker, {Joshua F} and Barbour, {Kamil E} and Barton, {Jennifer L} and Laura Cappelli and Fatimah Chamseddine and Michael George and Johnson, {Sindhu R} and Lara Kahale and Karam, {Basil S} and Khamis, {Assem M} and Iris Navarro-Mill{\'a}n and Reza Mirza and Pascale Schwab and Namrata Singh and Marat Turgunbaev and Turner, {Amy S} and Sally Yaacoub and Akl, {Elie A}",

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AU - Fraenkel, Liana

AU - Bathon, Joan M

AU - England, Bryant R

AU - St Clair, E William

AU - Arayssi, Thurayya

AU - Carandang, Kristine

AU - Deane, Kevin D

AU - Genovese, Mark

AU - Huston, Kent Kwas

AU - Kerr, Gail

AU - Kremer, Joel

AU - Nakamura, Mary C

AU - Russell, Linda A

AU - Singh, Jasvinder A

AU - Smith, Benjamin J

AU - Sparks, Jeffrey A

AU - Venkatachalam, Shilpa

AU - Weinblatt, Michael E

AU - Al-Gibbawi, Mounir

AU - Baker, Joshua F

AU - Barbour, Kamil E

AU - Barton, Jennifer L

AU - Cappelli, Laura

AU - Chamseddine, Fatimah

AU - George, Michael

AU - Johnson, Sindhu R

AU - Kahale, Lara

AU - Karam, Basil S

AU - Khamis, Assem M

AU - Navarro-Millán, Iris

AU - Mirza, Reza

AU - Schwab, Pascale

AU - Singh, Namrata

AU - Turgunbaev, Marat

AU - Turner, Amy S

AU - Yaacoub, Sally

AU - Akl, Elie A

PY - 2021/7

Y1 - 2021/7

N2 - 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.

AB - 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.

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DO - 10.1002/art.41752

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SP - 1108

EP - 1123

JO - Arthritis & rheumatology (Hoboken, N.J.)

JF - Arthritis & rheumatology (Hoboken, N.J.)

IS - 7

ER -

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

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