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Rheumatoid Arthritis HELP
Based on 31,033 articles published since 2009
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These are the 31033 published articles about Arthritis, Rheumatoid that originated from Worldwide during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
1 Guideline 2018 update of the APLAR recommendations for treatment of rheumatoid arthritis. 2019

Lau, Chak Sing / Chia, Faith / Dans, Leonila / Harrison, Andrew / Hsieh, Tsu Yi / Jain, Rahul / Jung, Seung Min / Kishimoto, Mitsumasa / Kumar, Ashok / Leong, Khai Pang / Li, Zhanguo / Lichauco, Juan Javier / Louthrenoo, Worawit / Luo, Shue Fen / Mu, Rong / Nash, Peter / Ng, Chin Teck / Suryana, Bagus / Wijaya, Linda Kurniaty / Yeap, Swan Sim. ·Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong. · Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore. · Department of Pediatrics, University of the Philippines Manila, Manila, Philippines. · Department of Clinical Epidemiology, University of the Philippines Manila, Manila, Philippines. · Department of Medicine, University of Otago Wellington, Wellington, New Zealand. · Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan. · Jaipur Arthritis Centre, Jaipur, India. · Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. · Immuno-Rheumatology Center, St Luke's International Hospital, St Luke's International University, Tokyo, Japan. · Department of Rheumatology, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, India. · Department of Rheumatology and Immunology, Beijing University People's Hospital, Beijing, China. · Rheumatology, Allergy and Immunology Center, St. Luke's Medical Center, Quezon City, Philippines. · Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. · Department of Rheumatology, Allergy, Immunology, Chang Gung Memorial Hospital, Taipei, Taiwan. · Department of Medicine, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia. · Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore. · Duke-NUS Medical School, Singapore, Singapore. · Department of Internal Medicine, Faculty of Medicine, Brawijaya University, Malang, Indonesia. · Sari Asih Ciputat Hospital, South Tangerang, Indonesia. · Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Malaysia. ·Int J Rheum Dis · Pubmed #30809944.

ABSTRACT: AIM: To update recommendations based on current best evidence concerning the treatment of rheumatoid arthritis (RA), focusing particularly on the role of targeted therapies, to inform clinicians on new developments that will impact their current practice. MATERIALS AND METHODS: A search of relevant literature from 2014 to 2016 concerning targeted therapies in RA was conducted. The RA Update Working Group evaluated the evidence and proposed updated recommendations using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, to describe the quality of evidence and strength of recommendations. Recommendations were finalized through consensus using the Delphi technique. RESULTS: This update provides 16 RA treatment recommendations based on current best evidence and expert clinical opinion. Recommendations 1-3 deal with the use of conventional synthetic disease-modifying antirheumatic drugs. The next three recommendations (4-6) cover the need for screening and management of infections and comorbid conditions prior to starting targeted therapy, while the following seven recommendations focus on use of these agents. We address choice of targeted therapy, switch, tapering and discontinuation. The last three recommendations elaborate on targeted therapy for RA in special situations such as pregnancy, cancer, and major surgery. CONCLUSION: Rheumatoid arthritis remains a significant health problem in the Asia-Pacific region. Patients with RA can benefit from the availability of effective targeted therapies, and these updated recommendations provide clinicians with guidance on their use.

2 Guideline Japan College of Rheumatology guideline for the use of methotrexate in patients with rheumatoid arthritis. 2019

Kameda, Hideto / Fujii, Takao / Nakajima, Ayako / Koike, Ryuji / Sagawa, Akira / Kanbe, Katsuaki / Tomita, Tetsuya / Harigai, Masayoshi / Suzuki, Yasuo / Anonymous1041117. ·a Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine , Toho University , Tokyo , Japan. · b Department of Rheumatology and Clinical Immunology , Wakayama Medical University , Wakayama , Japan. · c Department of Rheumatology, Center for Rheumatic Diseases , Mie University Graduate School of Medicine , Mie , Japan. · d Medical Innovation Promotion Center, Clinical Research Center of Medical Hospital, Tokyo Medical and Dental University , Tokyo , Japan. · e Sagawa Akira Rheumatology Clinic , Hokkaido , Japan. · f Department of Kuranomachi Community Medicine , Regional Clinical Education Center, Jichi Medical University , Tochigi , Japan. · g Department of Orthopaedic Biomaterial Science, Graduate School of Medicine , Osaka University , Osaka , Japan. · h Division of Epidemiology and Pharmacoepidemiology of Rheumatic Diseases , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan. · i Department of Internal Medicine, Division of Rheumatology , Tokai University School of Medicine , Kanagawa , Japan. ·Mod Rheumatol · Pubmed #29718746.

ABSTRACT: Methotrexate (MTX), the anchor drug in the current treatment strategy for rheumatoid arthritis (RA), was first approved for treatment of RA in Japan in 1999 at the recommended dose of 6-8 mg/week; it was approved as first-line drug with the maximum dose of 16 mg/week in February 2011. However, more than half of Japanese patients with RA are unable to tolerate a dose of 16 mg/week of MTX. Moreover, some serious adverse events during the treatment with MTX, such as pneumocystis pneumonia (PCP) and lymphoproliferative disorders (LPD) have been observed much more frequently in Japan than in other countries. Therefore, this article, an abridged English translation summarizing the 2016 update of the Japan College of Rheumatology (JCR) guideline for the use of MTX in Japanese patients with RA, is not intended to be valid for global use; however, it is helpful for the Japanese community of rheumatology and its understanding might be useful to the global community of rheumatology.

3 Guideline Diagnosis and management of rheumatoid arthritis in adults: summary of updated NICE guidance. 2018

Allen, Alex / Carville, Serena / McKenna, Frank / Anonymous2101080. ·National Guideline Centre, Royal College of Physicians, London NW1 4LE, UK. · Trafford General Hospital, Manchester University NHS Foundation Trust, Manchester M41 5SL, UK Frank.Mckenna@mft.nhs.uk. ·BMJ · Pubmed #30076129.

ABSTRACT: -- No abstract --

4 Guideline 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. 2018

Rausch Osthoff, Anne-Kathrin / Niedermann, Karin / Braun, Jürgen / Adams, Jo / Brodin, Nina / Dagfinrud, Hanne / Duruoz, Tuncay / Esbensen, Bente Appel / Günther, Klaus-Peter / Hurkmans, Emailie / Juhl, Carsten Bogh / Kennedy, Norelee / Kiltz, Uta / Knittle, Keegan / Nurmohamed, Michael / Pais, Sandra / Severijns, Guy / Swinnen, Thijs Willem / Pitsillidou, Irene A / Warburton, Louise / Yankov, Zhivko / Vliet Vlieland, Theodora P M. ·School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland. · Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands. · Rheumazentrum Ruhrgebiet, Herne, Germany. · Ruhr University, Bochum, Germany. · Faculty of Health Sciences and Arthritis Research UK Centre of Excellence for Sport, Exercise and Osteoarthritis, University of Southampton, Southampton, UK. · Department of Orthopaedics, Danderyd University Hospital Corp., Stockholm, Sweden. · Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden. · National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · PMR Department, Rheumatology Division, Marmara University, School of Medicine, Istanbul, Turkey. · Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet., Glostrup, Denmark. · Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. · University Center of Orthopaedics and Traumatology, University Medicine at Technische Universität Dresden, Dresden, Germany. · Department Social Affaire and Health, ECORYS Nederland BV, Rotterdam, Netherlands. · Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. · Departmentof Occupational and Physical Therapy, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen, Denmark. · School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland. · Department of Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland. · Department of Rheumatology, Amsterdam Rheumatology and immunology Center, VU University Medical Center, Amsterdam, The Netherlands. · Centre for Biomedical Research, University of Algarve, Faro, Portugal. · EULAR PARE Patient Research Partner, ReumaNet, Leuven, Belgium. · Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium. · Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium. · EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus. · Primary Health Care Sciences, Keele University, Keele, UK. · PRP (Patient Research Partner EULAR), Bulgarian Ankylosing Spondylitis Patient Society, Sofia, Bulgaria and ASIF (Ankylosing Spondylitis International Federation), London, UK. ·Ann Rheum Dis · Pubmed #29997112.

ABSTRACT: Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are applicable for people with inflammatory arthritis (iA; Rheumatoid Arthritis and Spondyloarthritis) and osteoarthritis (hip/knee OA) in order to develop evidence-based recommendations for advice and guidance on PA in clinical practice. The EULAR standardised operating procedures for the development of recommendations were followed. A task force (TF) (including rheumatologists, other medical specialists and physicians, health professionals, patient-representatives, methodologists) from 16 countries met twice. In the first TF meeting, 13 research questions to support a systematic literature review (SLR) were identified and defined. In the second meeting, the SLR evidence was presented and discussed before the recommendations, research agenda and education agenda were formulated. The TF developed and agreed on four overarching principles and 10 recommendations for PA in people with iA and OA. The mean level of agreement between the TF members ranged between 9.8 and 8.8. Given the evidence for its effectiveness, feasibility and safety, PA is advocated as integral part of standard care throughout the course of these diseases. Finally, the TF agreed on related research and education agendas. Evidence and expert opinion inform these recommendations to provide guidance in the development, conduct and evaluation of PA-interventions and promotion in people with iA and OA. It is advised that these recommendations should be implemented considering individual needs and national health systems.

5 Guideline Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis. 2018

Tenten-Diepenmaat, Marloes / van der Leeden, Marike / Vliet Vlieland, Thea P M / Dekker, Joost / Anonymous5390954. ·Amsterdam Rehabilitation Research Center | Reade, Amsterdam, the Netherlands. · 2Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands. · 0000 0004 0435 165X · grid.16872.3a · 3Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands. · 4Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands. · 0000000089452978 · grid.10419.3d ·J Foot Ankle Res · Pubmed #29988776.

ABSTRACT: Background: Foot problems in people with rheumatoid arthritis (RA) are highly prevalent and have a substantial impact on quality of life. Healthcare professionals from various professions can be involved in the management of these foot problems. There is currently no consensus on optimal management. Therefore, the aim of the present study was to develop multidisciplinary recommendations for the management of foot problems in people with RA in the Netherlands. Methods: The recommendations were based on research evidence and consensus among experts, following published strategies for the development of practice recommendations. The expert group was composed of 2 patients and 22 experienced professionals (rheumatologists, rehabilitation physicians, orthopaedic surgeons, specialized nurses, podiatrists, orthopaedic shoe technicians, pedicurists, and researchers) in the Netherlands. For each developed recommendation i) the level of evidence was determined, and ii) the level of agreement (among the expert group) was set by an anonymous voting procedure using a numeric rating scale. The mean and range of the level of agreement for each recommendation was calculated. A recommendation was approved when ≥70% of the expert group voted an NRS-agreement ≥7. Results: In total, 41 recommendations were developed. Two recommendations concerned a framework for diagnosis and treatment. Thirty-nine recommendations on foot care were developed: seven on diagnosis (including check-ups of feet and shoes and diagnostic imaging), 27 on treatment (including corticosteroid injections, foot surgery, therapeutic shoes, foot orthoses, exercise therapy, toe-orthoses and toenail-braces, treatment of toenails and skin), four on communication, and one on organisation of RA-related footcare. All recommendations were approved by the expert group. The percentage score of NRS-agreement ≥7 ranged from 80 to 100%. Conclusions: These are the first published multidisciplinary recommendations specific to the management of foot problems in people with RA. Multidisciplinary recommendations can provide guidance in timely referrals and access to adequate footcare. More research is needed to strengthen the evidence on diagnosis and treatment of RA-related foot problems. These national recommendations may be a first step towards developing international multidisciplinary recommendations for the management of foot problems in RA.

6 Guideline EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis. 2018

Geenen, Rinie / Overman, Cécile L / Christensen, Robin / Åsenlöf, Pernilla / Capela, Susana / Huisinga, Karen L / Husebø, Mai Elin P / Köke, Albère J A / Paskins, Zoe / Pitsillidou, Irene A / Savel, Carine / Austin, Judith / Hassett, Afton L / Severijns, Guy / Stoffer-Marx, Michaela / Vlaeyen, Johan W S / Fernández-de-Las-Peñas, César / Ryan, Sarah J / Bergman, Stefan. ·Department of Psychology, Utrecht University, Utrecht, The Netherlands. · Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. · Department of Rheumatology, Odense University Hospital, Odense, Denmark. · Department of Neuroscience, Uppsala University, Uppsala, Sweden. · Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Lisbon, Portugal. · Rheumatology Research Unit, Faculty of Medicine, Lisbon Academic Medical Centre, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal. · Department of Rheumatology, Virginia Mason Medical Center, Seattle, Washington, USA. · Norwegian National Unit for Rehabilitation for Rheumatic Patients with Special Needs, NBRR, Diakonhjemmet Hospital, Oslo, Norway. · Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands. · Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK. · Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK. · EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus. · Department of Rheumatology, CHU, Clermont Ferrand, Clermont Ferrand, France. · Department of Anesthesiology, Division of Pain Research, Chronic Pain & Fatigue Research Center, University of Michigan Medical School, Ann Harbor, Michigan, USA. · EULAR Social Leagues Patients' Representative, Leuven, Belgium. · Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria. · Department of Health Sciences, University of Applied Sciences FH Campus Wien, Vienna, Austria. · Research group Health Psychology, University of Leuven, Leuven, Belgium. · Behavioral Medicine Research, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands. · Department Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain. · Department of Public Health and Community Medicine, Primary Health Care Unit, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ·Ann Rheum Dis · Pubmed #29724726.

ABSTRACT: Pain is the predominant symptom for people with inflammatory arthritis (IA) and osteoarthritis (OA) mandating the development of evidence-based recommendations for the health professional's approach to pain management. A multidisciplinary task force including professionals and patient representatives conducted a systematic literature review of systematic reviews to evaluate evidence regarding effects on pain of multiple treatment modalities. Overarching principles and recommendations regarding assessment and pain treatment were specified on the basis of reviewed evidence and expert opinion. From 2914 review studies initially identified, 186 met inclusion criteria. The task force emphasised the importance for the health professional to adopt a patient-centred framework within a biopsychosocial perspective, to have sufficient knowledge of IA and OA pathogenesis, and to be able to differentiate localised and generalised pain. Treatment is guided by scientific evidence and the assessment of patient needs, preferences and priorities; pain characteristics; previous and ongoing pain treatments; inflammation and joint damage; and psychological and other pain-related factors. Pain treatment options typically include education complemented by physical activity and exercise, orthotics, psychological and social interventions, sleep hygiene education, weight management, pharmacological and joint-specific treatment options, or interdisciplinary pain management. Effects on pain were most uniformly positive for physical activity and exercise interventions, and for psychological interventions. Effects on pain for educational interventions, orthotics, weight management and multidisciplinary treatment were shown for particular disease groups. Underpinned by available systematic reviews and meta-analyses, these recommendations enable health professionals to provide knowledgeable pain-management support for people with IA and OA.

7 Guideline Biologic Disease-modifying antirheumatic drug attributes in the first lines of treatment of rheumatoid arthritis. 2015 ACORDAR project. 2018

Muñoz-Fernández, Santiago / Bustabad Reyes, María Sagrario / Calvo Alén, Jaime / Castaño Sánchez, Manuel / Chamizo Carmona, Eugenio / Corominas, Héctor / Fernández-Llanio Comella, Nagore / Hidalgo Calleja, María Cristina / Pérez Venegas, José Javier / Rodríguez Heredia, José Manuel / Romero Yuste, Susana María / Ruiz-Esquide Torino, Virginia / Anonymous7660892. ·Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, Madrid, España. Electronic address: santiago.munoz@salud.madrid.org. · Hospital Universitario de Canarias, Santa Cruz de Tenerife, España. · Hospital Universitario Araba, Vitoria, Álava, España. · Hospital Universitario Virgen de la Arrixaca, Murcia, España. · Hospital de Mérida , Mérida, Badajoz, España. · Hospital Moisés Broggi, Sant Joan Despí, Barcelona, España. · Hospital Arnau de Vilanova, Valencia, España. · Hospital Clínico de Salamanca, Salamanca, España. · Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, España. · Hospital Universitario de Getafe, Getafe, Madrid, España. · Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España. · Hospital Clínic i Provincial, Barcelona, España. ·Reumatol Clin · Pubmed #28065486.

ABSTRACT: OBJECTIVE: To date, between 17% and 35% of patients with rheumatoid arthritis (RA) do not respond as expected to the initial biological therapy. The objective of this project is to recognize and weigh the attributes of biologic DMARD (bDMARD) to identify the most appropriate for each case, in the first lines of treatment of RA (after inadequate response to at least one synthetic DMARD or previous bDMARD). METHODS: To recognize the possible attributes that could define the bDMARD, we performed a systematic search of the literature that recognized the possible attributes involving general aspects, pharmacology, efficacy, safety, management, and cost. Then a Delphi process was conducted with two rounds among a group of selected expert rheumatologists in the management of RA indicating the degree of agreement with the attributes identified in the literature. The project was completed between February and September 2015, indicating the degree of importance that was ascribed to each attribute. Two criteria were applied to determine the consistency of results: 1) based on the median and interquartile range; and 2) on the simultaneous compliance with mean, median, standard deviation, interquartile range and coefficient of variation. The agreement and final ratification of the expert panel were also determined. RESULTS: Eighty-three Spanish rheumatologists participated and completed both rounds of the Delphi process. In no case was the importance of the 77 attributes identified considered to be low; 75 of 77 (97.4%) were considered highly important and 76 of 77 (98.7%) were ratified. Fifteen attributes had the support of 100% of the working group. CONCLUSIONS: There was a high degree of agreement concerning the selected attributes. Fifteen of them had the support of 100% of the working group and could be considered the definition of the ideal bDMARD in the first lines of RA treatment.

8 Guideline Recommendations for the use of ultrasound and magnetic resonance in patients with rheumatoid arthritis. 2018

Möller, Ingrid / Loza, Estibaliz / Uson, Jacqueline / Acebes, Carlos / Andreu, Jose Luis / Batlle, Enrique / Bueno, Ángel / Collado, Paz / Fernández-Gallardo, Juan Manuel / González, Carlos / Jiménez Palop, Mercedes / Lisbona, María Pilar / Macarrón, Pilar / Maymó, Joan / Narváez, Jose Antonio / Navarro-Compán, Victoria / Sanz, Jesús / Rosario, M Piedad / Vicente, Esther / Naredo, Esperanza. ·Servicio de Reumatología, Instituto Poal de Reumatología, Barcelona, España. · Instituto de Salud Musculoesquelética, Madrid, España. Electronic address: estibaliz.loza@inmusc.eu. · Servicio de Reumatología, Hospital Universitario de Móstoles, Madrid, España. · Servicio de Reumatología, Hospital General de Villalba, Collado Villalba, Madrid, España. · Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España. · Servicio de Reumatología, Hospital Universitario Sant Joan d'Alacant, Alicante, España. · Servicio de Radiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España. · Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España. · Servicio de Radiología, Hospital Universitario Severo Ochoa, Madrid, Madrid, España. · Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España. · Hospital del Mar, Barcelona, España. · Servicio de Reumatología, Hospital Universitario Clínico San Carlos, Madrid, España. · Servicio de Reumatología, Hospital del Mar, Barcelona, España. · Servicio de Radiodiagnóstico, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. · Servicio de Reumatología, Hospital Universitario La Paz, idiPaz, Madrid, España. · Servicio Andaluz de Salud, Sevilla, España. · Servicio de Reumatología, Hospital Universitario de la Princesa, Madrid, España. ·Reumatol Clin · Pubmed #28029551.

ABSTRACT: OBJECTIVE: To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA). METHODS: Recommendations were generated following a nominal group technique. A panel of experts, consisting of 15 rheumatologists and 3 radiologists, was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of experts voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. RESULTS: A total of 20 recommendations were proposed. They include the validity of US and MRI regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. CONCLUSIONS: These recommendations will help clinicians use US and MRI in RA patients.

9 Guideline Inflammatory arthritis or osteoarthritis of the knee - Efficacy of intra-joint infiltration of methylprednisolone acetate versus triamcinolone acetonide or triamcinolone hexacetonide. 2017

Anonymous2090931 / Silvinato, Antonio / Bernardo, Wanderley Marques. ·Associação Médica Brasileira (AMB). ·Rev Assoc Med Bras (1992) · Pubmed #29267483.

ABSTRACT: -- No abstract --

10 Guideline The British Society for Rheumatology guideline for the management of adults with primary Sjögren's Syndrome. 2017

Price, Elizabeth J / Rauz, Saaeha / Tappuni, Anwar R / Sutcliffe, Nurhan / Hackett, Katie L / Barone, Francesca / Granata, Guido / Ng, Wan-Fai / Fisher, Benjamin A / Bombardieri, Michele / Astorri, Elisa / Empson, Ben / Larkin, Genevieve / Crampton, Bridget / Bowman, Simon J / Anonymous461089. ·Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon. · Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham. · Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham. · Institute of Dentistry, Queen Mary University of London. · Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Barts Health NHS Trust, London. · Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University & Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne. · Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne. · Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham. · Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. · Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London. · Community Rheumatology department, Modality partnership, Birmingham. · Ophthalmology, Kings College Hospital, London. · British Sjögren's Syndrome Association, Birmingham, UK. ·Rheumatology (Oxford) · Pubmed #28957550.

ABSTRACT: -- No abstract --

11 Guideline The British Society for Rheumatology guideline for the management of adults with primary Sjögren's Syndrome. 2017

Price, Elizabeth J / Rauz, Saaeha / Tappuni, Anwar R / Sutcliffe, Nurhan / Hackett, Katie L / Barone, Francesca / Granata, Guido / Ng, Wan-Fai / Fisher, Benjamin A / Bombardieri, Michele / Astorri, Elisa / Empson, Ben / Larkin, Genevieve / Crampton, Bridget / Bowman, Simon J / Anonymous790921. ·Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon. · Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham. · Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham. · Institute of Dentistry, Queen Mary University of London. · Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Barts Health NHS Trust, London. · Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University & Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne. · Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne. · Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham. · Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. · Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London. · Community Rheumatology department, Modality partnership, Birmingham. · Ophthalmology, Kings College Hospital, London. · British Sjögren's Syndrome Association, Birmingham, UK. ·Rheumatology (Oxford) · Pubmed #28957549.

ABSTRACT: -- No abstract --

12 Guideline 2016 updated Thai Rheumatism Association Recommendations for the use of biologic and targeted synthetic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis. 2017

Louthrenoo, Worawit / Kasitanon, Nuntana / Katchamart, Wanruchada / Aiewruengsurat, Duangkamol / Chevaisrakul, Parawee / Chiowchanwisawakit, Praveena / Dechanuwong, Pornchai / Hanvivadhanakul, Punchong / Mahakkanukrauh, Ajanee / Manavathongchai, Siriporn / Muangchan, Chayawee / Narongroeknawin, Pongthorn / Phumethum, Veerapong / Siripaitoon, Boonjing / Suesuwan, Anawat / Suwannaroj, Siraphop / Uea-Areewongsa, Parichat / Ukritchon, Sittichai / Asavatanabodee, Paijit / Koolvisoot, Ajchara / Nanagara, Ratanavadee / Totemchokchyakarn, Kitti / Nuntirooj, Kanokrut / Kitumnuaypong, Tasanee. ·Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. · Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. · Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand. · Division of Allergy Immunology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. · Department of Internal Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. · Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand. · Division of Allergy Immunology and Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. · Division of Rheumatology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand. · Division of Rheumatology, Department of Internal Medicine, Pha Pok Klao Hospital, Chanthaburi, Thailand. · Vibhavadi Hospital, Bangkok, Thailand. · Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. · Rheumatic Disease Unit, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand. · Rheumatology Unit, Department of Medicine, Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand. ·Int J Rheum Dis · Pubmed #28730640.

ABSTRACT: AIM: In June 2015, the Thai Rheumatism Association (TRA) approved an update of its recommendation for the use of biologic disease-modifying anti-rheumatic drugs (bDMARDs) and targeted synthetic (tsDMARD) in the treatment of rheumatoid arthritis (RA) to cover those currently available in Thailand (etanercept, infliximab, golimumab, rituximab, tocilizumab, abatacept and tofacitinib). METHOD: A search of the literature was performed between January 2000 and June 2015. Existing RA recommendations, in relation to the use of bDMARDs and tsDMARD, were identified and evaluated by the AGREE II instrument prior to their use as a 'guide' for developing this TRA recommendation. An additional literature search was performed in order to answer specific clinical questions that could not be found in existing guidelines. RESULT: Thirteen recommendations were developed. They covered the use of RA classification criteria, the aim of RA treatment, when to initiate bDMARDs/tsDMARD or taper or switch them to other medications, as well as monitoring these drugs during their use. In addition, specific issues including their use and vaccination, malignancies, pregnancy and lactation, and perioperative period also were addressed. Public hearings were performed at the annual meeting of the TRA and of the Royal College of Physicians of Thailand. The recommendations were distributed to other professional associations related to RA management, as well as government sectors associated with the reimbursement policy, prior to development of the final version. CONCLUSION: These recommendations will help Thai rheumatologists prescribe bDMARDs and tsDMARD more appropriately when treating RA patients.

13 Guideline 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. 2017

Goodman, Susan M / Springer, Bryan / Guyatt, Gordon / Abdel, Matthew P / Dasa, Vinod / George, Michael / Gewurz-Singer, Ora / Giles, Jon T / Johnson, Beverly / Lee, Steve / Mandl, Lisa A / Mont, Michael A / Sculco, Peter / Sporer, Scott / Stryker, Louis / Turgunbaev, Marat / Brause, Barry / Chen, Antonia F / Gililland, Jeremy / Goodman, Mark / Hurley-Rosenblatt, Arlene / Kirou, Kyriakos / Losina, Elena / MacKenzie, Ronald / Michaud, Kaleb / Mikuls, Ted / Russell, Linda / Sah, Alexander / Miller, Amy S / Singh, Jasvinder A / Yates, Adolph. ·Susan M. Goodman, MD, Lisa A. Mandl, MD, MPH, Peter Sculco, MD, Barry Brause, MD, Kyriakos Kirou, MD, Ronald MacKenzie, MD, Linda Russell, MD: Hospital for Special Surgery/Weill Cornell Medicine, New York, New York. Electronic address: goodmans@hss.edu. · Bryan Springer, MD: OrthoCarolina Hip and Knee Center, Charlotte, North Carolina. · Gordon Guyatt, MD: McMaster University, Hamilton, Ontario, Canada. · Matthew P. Abdel, MD: Mayo Clinic, Rochester, Minnesota. · Vinod Dasa, MD: Louisiana State University, New Orleans. · Michael George, MD: University of Pennsylvania, Philadelphia. · Ora Gewurz-Singer, MD: University of Michigan, Ann Arbor. · Jon T. Giles, MD, MPH: Columbia University, New York, New York. · Beverly Johnson, MD: Albert Einstein College of Medicine, Bronx, New York. · Steve Lee, DO: Kaiser Permanente, Fontana, California. · Susan M. Goodman, MD, Lisa A. Mandl, MD, MPH, Peter Sculco, MD, Barry Brause, MD, Kyriakos Kirou, MD, Ronald MacKenzie, MD, Linda Russell, MD: Hospital for Special Surgery/Weill Cornell Medicine, New York, New York. · Michael A. Mont, MD: Cleveland Clinic, Cleveland, Ohio. · Scott Sporer, MD: Midwest Orthopaedics at Rush, Chicago, Illinois. · Louis Stryker, MD: University of Texas Medical Branch, Galveston. · Marat Turgunbaev, MD, MPH, Amy S. Miller: American College of Rheumatology, Atlanta, Georgia. · Antonia F. Chen, MD, MBA: Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. · Jeremy Gililland, MD: University of Utah, Salt Lake City. · Mark Goodman, MD, Adolph Yates, MD: University of Pittsburgh, Pittsburgh, Pennsylvania. · Arlene Hurley-Rosenblatt, ANP: Rockefeller University, New York, New York. · Elena Losina, PhD: Brigham and Women's Hospital, Boston, Massachusetts. · Kaleb Michaud, PhD: National Data Bank for Rheumatic Diseases, Wichita, Kansas and University of Nebraska Medical Center, Omaha. · Ted Mikuls, MD, MSPH: University of Nebraska Medical Center, Omaha. · Alexander Sah, MD: Dearborn-Sah Institute for Joint Restoration, Fremont, California. · Jasvinder A. Singh, MBBS, MPH: University of Alabama at Birmingham. ·J Arthroplasty · Pubmed #28629905.

ABSTRACT: OBJECTIVE: This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). METHODS: A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. RESULTS: The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional and based on low- or moderate-quality evidence. CONCLUSION: This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA. These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data.

14 Guideline 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. 2017

Goodman, Susan M / Springer, Bryan / Guyatt, Gordon / Abdel, Matthew P / Dasa, Vinod / George, Michael / Gewurz-Singer, Ora / Giles, Jon T / Johnson, Beverly / Lee, Steve / Mandl, Lisa A / Mont, Michael A / Sculco, Peter / Sporer, Scott / Stryker, Louis / Turgunbaev, Marat / Brause, Barry / Chen, Antonia F / Gililland, Jeremy / Goodman, Mark / Hurley-Rosenblatt, Arlene / Kirou, Kyriakos / Losina, Elena / MacKenzie, Ronald / Michaud, Kaleb / Mikuls, Ted / Russell, Linda / Sah, Alexander / Miller, Amy S / Singh, Jasvinder A / Yates, Adolph. ·Hospital for Special Surgery/Weill Cornell Medicine, New York, New York. · OrthoCarolina Hip and Knee Center, Charlotte, North Carolina. · McMaster University, Hamilton, Ontario, Canada. · Mayo Clinic, Rochester, Minnesota. · Louisiana State University, New Orleans. · University of Pennsylvania, Philadelphia. · University of Michigan, Ann Arbor. · Columbia University, New York, New York. · Albert Einstein College of Medicine, Bronx, New York. · Kaiser Permanente, Fontana, California. · Cleveland Clinic, Cleveland, Ohio. · Midwest Orthopaedics at Rush, Chicago, Illinois. · University of Texas Medical Branch, Galveston. · American College of Rheumatology, Atlanta, Georgia. · Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. · University of Utah, Salt Lake City. · University of Pittsburgh, Pittsburgh, Pennsylvania. · Rockefeller University, New York, New York. · Brigham and Women's Hospital, Boston, Massachusetts. · National Data Bank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center, Omaha. · University of Nebraska Medical Center, Omaha. · Dearborn-Sah Institute for Joint Restoration, Fremont, California. · University of Alabama at Birmingham. ·Arthritis Rheumatol · Pubmed #28620948.

ABSTRACT: OBJECTIVE: This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). METHODS: A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. RESULTS: The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional and based on low- or moderate-quality evidence. CONCLUSION: This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA. These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data.

15 Guideline Recommendations for infectious disease screening in migrants to Western Europe with inflammatory arthropathies before starting biologic agents. Results from a multidisciplinary task force of four European societies (SIR, SER, SIMET, SEMTSI) facing the largest impact of the flow of migrants today. 2017

Bartalesi, Filippo / Scirè, Carlo / Requena-Méndez, Ana / Abad, Miguel Angel / Buonfrate, Dora / Caporali, Roberto / Conti, Fabrizio / Diaz-Gonzalez, Federico / Fernández-Espartero, Cruz / Martinez-Fernandez, Carmen / Mascarello, Marta / Generali, Elena / Minisola, Giovanni / Morrone, Aldo / Muñoz, José / Richi, Patricia / Sakellariou, Gariffalia / Salas Coronas, Joaquin / Spinicci, Michele / Castelli, Francesco / Bartoloni, Alessandro / Bisoffi, Zeno / Gimenez-Sanchez, Francisco / Muñoz-Fernandez, Santiago / Matucci-Cerinic, Marco. ·SOD Malattie Infettive e Tropicali, Careggi Hospital, Florence, Italy. · Rheumatology Unit, Department of Medical Sciences, University of Ferrara, and Epidemiology Unit, Italian Society for Rheumatology, Milano, Italy. · Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic, Universitat de Barcelona, Spain. · Division of Rheumatology, Hospital Virgen del Puerto, Plasencia, Spain. · Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar, Verona, Italy. · Division of Rheumatology, University of Pavia, IRCCS S. Matteo Foundation, Pavia, Italy. · Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University, Rome, Italy. · Department of Medicine, Universidad de La Laguna, Division of Rheumatology, Hospital Universitario de Canarias, La Laguna, Spain. · Servicio de Reumatologia, Hospital Universitario de Mostoles, Madrid, Spain. · Research Unit, Spanish Society of Rheumatology, Madrid, Spain. · Infectious Diseases Unit, University Hospital of Trieste, Italy. · Division of Rheumatology, San Camillo Hospital, Rome, Italy. · General Directorate, San Camillo Hospital, Rome, Italy. · Division of Rheumatology, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain. · University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Italy. · Unidad de Vacunación Internacional, Instituto Hispalense de Pediatría, Granada; and Spanish Society of Tropical Medicine and International Health, Spain. · Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Italy. marco.matuccicerinic@unifi.it. ·Clin Exp Rheumatol · Pubmed #28516869.

ABSTRACT: OBJECTIVES: Inflammatory arthritis needs infectious disease screening before starting a biologic agent, however, few data are known about migrant patients, who represent a peculiar population which requires a multidisciplinary approach among international health specialists and should also be considered by health authorities. For this reason, the Italian and Spanish Societies of Rheumatology (SIR and SER) and Tropical Medicine (SIMET and SEMTSI) promoted a multidisciplinary task force in order to produce specific recommendations about screening and advices to be considered in migrant patients with inflammatory arthritis candidate to receive biological therapy, according to their geographical origin. METHODS: The experts provided a prioritised list of research questions and the eligible spectrum of inflammatory arthritis, biologic drugs and infectious disease were defined in order to perform a systematic literature review. A search was made in Medline, Embase and Cochrane library, updated to March 2015. Ubiquitous infections and HBV, HCV, HIV and tuberculosis that are already considered in national and international recommendations, were not included. The strength of each recommendation was determined. RESULTS: The task force members agreed on 7 overarching principles. The risk of reactivation of selected potentially latent infectious disease was addressed in migrants with inflammatory arthritis candidates for biologics was considered and 15 potentially relevant infections were identified. CONCLUSIONS: Fifteen disease-specific recommendations were formulated on the basis of high level of agreement among the experts panel.

16 Guideline Using a modified Delphi process to establish clinical consensus for the diagnosis, risk assessment and abatacept treatment in patients with aggressive rheumatoid arthritis. 2017

Caporali, Roberto / Carletto, Antonio / Conti, Fabrizio / D'Angelo, Salvatore / Foti, Rosario / Gremese, Elisa / Govoni, Marcello / Iannone, Florenzo / Pellerito, Raffaele / Sinigaglia, Luigi. ·Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy. roberto.caporali@unipv.it. · Rheumatology Unit, University of Verona, Italy. · Rheumatology, Department of Internal Medicine, University "La Sapienza", Rome, Italy. · Rheumatology Department, S. Carlo Hospital, Potenza, Italy. · Rheumatology Unit, Vittorio Emanuele Hospital, Catania, Italy. · Rheumatology Unit, Catholic University of the Sacred Heart, Rome, Italy. · Rheumatology Department, S. Anna University, Ferrara, Italy. · Rheumatology, University of Bari, Italy. · Rheumatology Unit, Ospedale Mauriziano, Turin, Italy. · Rheumatology Department, University of Milan, Italy. ·Clin Exp Rheumatol · Pubmed #28281459.

ABSTRACT: OBJECTIVES: We aimed to formulate consensus statements for the identification of patients with rheumatoid arthritis (RA) who may benefit most from abatacept treatment, in order to clear up points related to its use in rheumatology. METHODS: Two rounds of a modified Delphi process were conducted. In the first round, a board of experts defined a list of consensus statements based on data derived from a non-systematic review on the use of abatacept in adult RA patients. In the second round, clinicians with extensive experience in the treatment of RA were invited to express individually agreement on the statements, using a dedicated online platform. A face-to-face meeting of the board was held after round two. Consensus was defined as 75% agreement. RESULTS: In Delphi process round one, a board of 10 experts defined a list of 20 consensus statements on abatacept treatment. Then, a panel of 37 rheumatologists participated in round two. The majority of clinicians (75.7%) had 10 or more years of experience in the treatment of RA patients. Fifteen of the 20 statements reached the defined level of consensus. CONCLUSIONS: Identified consensus statements may help clinicians to apply to routine-care settings results from clinical studies and clinical recommendations, providing a guide for the initiation of abatacept treatment in RA patients.

17 Guideline Standardisation of labial salivary gland histopathology in clinical trials in primary Sjögren's syndrome. 2017

Fisher, Benjamin A / Jonsson, Roland / Daniels, Troy / Bombardieri, Michele / Brown, Rachel M / Morgan, Peter / Bombardieri, Stefano / Ng, Wan-Fai / Tzioufas, Athanasios G / Vitali, Claudio / Shirlaw, Pepe / Haacke, Erlin / Costa, Sebastian / Bootsma, Hendrika / Devauchelle-Pensec, Valerie / Radstake, Timothy R / Mariette, Xavier / Richards, Andrea / Stack, Rebecca / Bowman, Simon J / Barone, Francesca / Anonymous451201. ·Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK. · Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK. · Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway. · Department of Rheumatology, Haukeland University Hospital, Bergen, Norway. · Department of Orofacial Sciences, University of California San Francisco, San Francisco California, USA. · Centre for Experimental Medicine and Rheumatology, Queen Mary University of London, London, UK. · Department of Pathology, University Hospitals Birmingham NHS Trust, Birmingham, UK. · Department of Pathology, King's College London, London, UK. · Rheumatology Unit, University of Pisa, Pisa, Italy. · Musculoskeletal Research Group and NIHR Biomedical Research Centre in Ageing and Chronic Diseases, Newcastle University, Newcastle, UK. · Department of Pathophysiology, University of Athens, Athens, Greece. · Section of Rheumatology, Casa di Cura di Lecco, Lecco, Italy. · Department of Oral Medicine, King's College London, London, UK. · Department of Pathology, University of Groningen, Groningen, The Netherlands. · Department of Pathology, Brest University Hospital, Brest, France. · Department of Rheumatology and Clinical Immunology, University of Groningen, Groningen, The Netherlands. · Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, ER129, Brest, France. · Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands. · Rheumatology Department, Université Paris-Sud, Assistance Publique-Hôpitaux de Paris, INSERM U1184, Le Kremlin-Bicêtre, France. · Department of Oral Medicine, Dental Hospital, Birmingham, UK. ·Ann Rheum Dis · Pubmed #27965259.

ABSTRACT: Labial salivary gland (LSG) biopsy is used in the classification of primary Sjögren's syndrome (PSS) and in patient stratification in clinical trials. It may also function as a biomarker. The acquisition of tissue and histological interpretation is variable and needs to be standardised for use in clinical trials. A modified European League Against Rheumatism consensus guideline development strategy was used. The steering committee of the ad hoc working group identified key outstanding points of variability in LSG acquisition and analysis. A 2-day workshop was held to develop consensus where possible and identify points where further discussion/data was needed. These points were reviewed by a subgroup of experts on PSS histopathology and then circulated via an online survey to 50 stakeholder experts consisting of rheumatologists, histopathologists and oral medicine specialists, to assess level of agreement (0-10 scale) and comments. Criteria for agreement were a mean score ≥6/10 and 75% of respondents scoring ≥6/10. Thirty-nine (78%) experts responded and 16 points met criteria for agreement. These points are focused on tissue requirements, identification of the characteristic focal lymphocytic sialadenitis, calculation of the focus score, identification of germinal centres, assessment of the area of leucocyte infiltration, reporting standards and use of prestudy samples for clinical trials. We provide standardised consensus guidance for the use of labial salivary gland histopathology in the classification of PSS and in clinical trials and identify areas where further research is required to achieve evidence-based consensus.

18 Guideline Recommendations by the Spanish Society of Rheumatology for the management of patients diagnosed with rheumatoid arthritis who cannot be treated with methotrexate. 2017

García-Vicuña, Rosario / Martín-Martínez, María Auxiliadora / Gonzalez-Crespo, María Rosa / Tornero-Molina, Jesús / Fernández-Nebro, Antonio / Blanco-García, Francisco Javier / Blanco-Alonso, Ricardo / Marsal-Barril, Sara / Anonymous11400886. ·Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-IP, Madrid, España. · Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España. · Servicio de Reumatología, Hospital 12 de Octubre, Madrid, España. · Servicio de Reumatología, Hospital Universitario de Guadalajara, Guadalajara, España. · Servicio de Reumatología, Hospital Universitario Regional de Málaga, Málaga, España. · Servicio de Reumatología, Complejo Hospitalario A Coruña, A Coruña, España. · Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Santander, España. · Servicio de Reumatología, Hospital Universitario Vall d'Hebron, Barcelona, España. Electronic address: smarsal@grr.pcb.ub.cat. ·Reumatol Clin · Pubmed #27825791.

ABSTRACT: To establish a set of recommendations for the management of patients diagnosed with rheumatoid arthritis (RA) who cannot be treated with methotrexate (MTX) due to contraindications, drug toxicity or lack of adherence, and to establish therapeutic strategies more effective and safer in these RA patients. A qualitative analysis of the scientific evidence available to June 2015. The 2-round Delphi technique of consensus was used to collect and establish expert opinion based on the participants' clinical experience when only low quality evidence was available. A total of eighteen recommendations were developed for the management of this patient profile. Fourteen of these recommendations were related to drug safety aspects. Recommendations on contraindication and toxicity of MTX have been updated. The experts recommend the use of biological monotherapy, a preferred treatment option, in patients whose profiles reveal a contraindication, intolerance or circumstances that prevent us against the use of MTX. There is some high-quality scientific evidence that supports contraindication and establishes certain conditions of MTX use in RA patients with specific clinical profiles.

19 Guideline EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. 2017

Agca, R / Heslinga, S C / Rollefstad, S / Heslinga, M / McInnes, I B / Peters, M J L / Kvien, T K / Dougados, M / Radner, H / Atzeni, F / Primdahl, J / Södergren, A / Wallberg Jonsson, S / van Rompay, J / Zabalan, C / Pedersen, T R / Jacobsson, L / de Vlam, K / Gonzalez-Gay, M A / Semb, A G / Kitas, G D / Smulders, Y M / Szekanecz, Z / Sattar, N / Symmons, D P M / Nurmohamed, M T. ·Departments of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade & VU University Medical Center, Amsterdam, The Netherlands. · Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway. · College of Medical, Veterinary and Life Sciences, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK. · Internal and Vascular Medicine, VU University Medical Center, Amsterdam, The Netherlands. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Department of Rheumatology, Paris Descartes University, Hôpital Cochin. Assistance Publique, Hôpitaux de Paris INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France. · Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria. · IRCCS Galeazzi Orthopedic Institute, Milan, Italy. · Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark. · Sygehus Sønderjylland (Hospital of Southern Jutland), Aabenraa, Denmark. · King Christian 10's Hospital for Rheumatic Diseases, Graasten, Denmark. · Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå, Sweden. · PARE (patient research partners), Sint-Joris-Weert, Belgium. · Romanian League Against Rheumatism (Vice-President) and Board Member (General Secretary) of AGORA, the Platform of S-E organisations for patients with RMDs, Bucharest, Romania. · Oslo University Hospital, Ullevål, Center for Preventive Medicine and Medical Faculty, University of Oslo, Oslo, Norway. · Department of Rheumatology & Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg and Section of Rheumatology, Lund, Sweden. · Department of Clinical Sciences Malmö, Lund University, Lund, Sweden. · Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium. · University of Cantabria, IDIVAL, Santander, Spain. · Head of Research and Development, Academic Affairs Dudley Group NHS Foundation Trust, Arthritis Research UK Centre for Epidemiology, University of Manchester, Russells Hall Hospital, Clinical Research Unit, Dudley, UK. · Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, University of Debrecen, Debrecen, Hungary. · Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK. · Department of Rheumatology and Musculoskeletal Epidemiology, Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK. · Department of Rheumatology Reade, Amsterdam Rheumatology and Immunology Center, Reade & VU University Medical Center, Amsterdam, The Netherlands. ·Ann Rheum Dis · Pubmed #27697765.

ABSTRACT: Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.

20 Guideline Evidence-based recommendations for the diagnosis and management of rheumatoid arthritis for non-rheumatologists: Integrating systematic literature research and expert opinion of the Thai Rheumatism Association. 2017

Katchamart, Wanruchada / Narongroeknawin, Pongthorn / Chevaisrakul, Parawee / Dechanuwong, Pornchai / Mahakkanukrauh, Ajanee / Kasitanon, Nuntana / Pakchotanon, Rattapol / Sumethkul, Kittiwan / Ueareewongsa, Parichat / Ukritchon, Sittichai / Bhurihirun, Thitirat / Duangkum, Kittikorn / Intapiboon, Porntip / Intongkam, Samanan / Jangsombatsiri, Wimol / Jatuworapruk, Kanon / Kositpesat, Naravadee / Leungroongroj, Pawinee / Lomarat, Wiyanoot / Petcharat, Chonachan / Sittivutworapant, Siriluck / Suebmee, Patcharawan / Tantayakom, Pongchirat / Tipsing, Worakan / Asavatanabodee, Paijit / Chiowchanwisawakit, Praveena / Foocharoen, Chingching / Koolvisoot, Ajchara / Louthrenoo, Worawit / Siripaitoon, Boonjing / Totemchokchyakarn, Kitti / Kitumnuaypong, Tasanee / Anonymous350876. ·Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand. · Division of Rheumatology, Department of Medicine, Pramongkutklao and College of Medicine, Bangkok, Thailand. · Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol, Bangkok, Thailand. · Division of Rheumatology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. · Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. · Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. · Rheumatology Unit, Department of Internal Medicine, Rajavithi Hospital, Bangkok, Thailand. · Division of Rheumatology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand. · Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. ·Int J Rheum Dis · Pubmed #27452207.

ABSTRACT: AIM: Rheumatoid arthritis (RA) is a chronic inflammatory joint disease leading to joint damage, functional disability, poor quality of life and shortened life expectancy. Early diagnosis and aggressive treatment are a principal strategy to improve outcomes. To provide best practices in the diagnosis and management of patients with RA, the Thai Rheumatism Association (TRA) developed scientifically sound and clinically relevant evidence-based recommendations for general practitioners, internists, orthopedists, and physiatrists. METHODS: Thirty-seven rheumatologists from across Thailand formulated 18 clinically relevant questions: three for diagnosis, 10 for treatments, four for monitoring, and one for referral. A bibliographic team systematically reviewed the relevant literature on these topics up to December 2013. A set of recommendations was proposed based on the results of systematic reviews combined with expert opinions. Group consensus was achieved for all statements and recommendations using the nominal group technique. RESULTS: A set of recommendations was proposed. For diagnosis, either American College of Rheumatology (ACR) 1987 or ACR/European League Against Rheumatism 2010 classification criteria can be applied. For treatment, nonsteroidal anti-inflammatory drugs, glucocorticoid, and disease-modifying antirheumatic drugs, including antimalarials, methotrexate and sulfasalazine are recommended. Physiotherapy should be suggested to all patients. Tight control strategy and monitoring for efficacy and side effects of treatments, as well as indications for referral to a rheumatologist are provided. CONCLUSIONS: These evidence-based recommendations provide practical guidance for diagnosis, fundamental management and referral of patients with RA for non-rheumatologists. However, it should be incorporated with clinical judgments and decisions about care for each individual patient.

21 Guideline Treatment Guidelines for Rheumatologic Manifestations of Sjögren's Syndrome: Use of Biologic Agents, Management of Fatigue, and Inflammatory Musculoskeletal Pain. 2017

Carsons, Steven E / Vivino, Frederick B / Parke, Ann / Carteron, Nancy / Sankar, Vidya / Brasington, Richard / Brennan, Michael T / Ehlers, William / Fox, Robert / Scofield, Hal / Hammitt, Katherine M / Birnbaum, Julius / Kassan, Stuart / Mandel, Steven. ·Winthrop-University Hospital Campus, State University of New York, Stony Brook, Mineola. · University of Pennsylvania, Philadelphia. · University of Connecticut Health Center, Farmington. · University of California at San Francisco. · University of Texas San Antonio Dental School, San Antonio. · Washington University, St. Louis, Missouri. · Carolinas Medical Center, Charlotte, North Carolina. · Scripps Memorial Hospital Xi-Med, La Jolla, California. · University of Oklahoma Health Sciences Center, Oklahoma Medical Research Foundation, and Oklahoma City Department of Veterans Affairs Medical Center, Oklahoma City. · Sjögren's Syndrome Foundation, Bethesda, Maryland. · Johns Hopkins University, Baltimore, Maryland. · University of Colorado, Denver. · Lenox Hill Hospital, New York, and Hofstra Northwell School of Medicine, Hempstead, New York. ·Arthritis Care Res (Hoboken) · Pubmed #27390247.

ABSTRACT: OBJECTIVE: The Sjögren's Syndrome Foundation clinical practice guidelines (CPGs) are designed to improve quality and consistency of care in Sjögren's syndrome by offering recommendations for management. METHODS: Management questions for the systemic manifestations of Sjögren's syndrome were posed by the CPG committee with input from patients and rheumatologists. Clinical questions were assigned to a topic review group that performed systematic reviews and data extraction and drafted guidelines. Quality of evidence and strength of recommendation were rated using the American Society of Clinical Oncology's modification of the Grading of Recommendations Assessment, Development, and Evaluation. Guideline recommendations were reviewed by a consensus expert panel (CEP) composed of 30-40 clinicians from academia and community practices, as well as registered nurses and patients, using a modified Delphi process. A CEP agreement level of 75% was set as a minimum for adoption of a guideline recommendation. RESULTS: Consensus was achieved for 19 recommendations; for 11 additional modules, available data were insufficient to allow a recommendation to be formulated. Of the 19 recommendations, 15 required 1 Delphi round, 2 required 2 rounds, and 2 required 3 rounds. CONCLUSION: Key recommendations include a decision tree for the use of oral disease-modifying antirheumatic drugs for inflammatory musculoskeletal pain, use of self-care measures and advice regarding exercise to reduce fatigue, and the use of rituximab in selected clinical settings for oral and ocular dryness and for certain extraglandular manifestations, including vasculitis, severe parotid swelling, inflammatory arthritis, pulmonary disease, and mononeuritis multiplex. The CPG committee strongly discouraged the use of tumor necrosis factor inhibitors for sicca symptoms and for the majority of clinical contexts in primary Sjögren's syndrome.

22 Guideline Clinical practice guidelines for oral management of Sjögren disease: Dental caries prevention. 2016

Zero, Domenick T / Brennan, Michael T / Daniels, Troy E / Papas, Athena / Stewart, Carol / Pinto, Andres / Al-Hashimi, Ibtisam / Navazesh, Mahvash / Rhodus, Nelson / Sciubba, James / Singh, Mabi / Wu, Ava J / Frantsve-Hawley, Julie / Tracy, Sharon / Fox, Philip C / Ford, Theresa Lawrence / Cohen, Stephen / Vivino, Frederick B / Hammitt, Katherine M / Anonymous6370854. · ·J Am Dent Assoc · Pubmed #26762707.

ABSTRACT: BACKGROUND: Salivary dysfunction in Sjögren disease can lead to serious and costly oral health complications. Clinical practice guidelines for caries prevention in Sjögren disease were developed to improve quality and consistency of care. METHODS: A national panel of experts devised clinical questions in a Population, Intervention, Comparison, Outcomes format and included use of fluoride, salivary stimulants, antimicrobial agents, and nonfluoride remineralizing agents. The panel conducted a systematic search of the literature according to pre-established parameters. At least 2 members extracted the data, and the panel rated the strength of the recommendations by using a variation of grading of recommendations, assessment, development, and evaluation. After a Delphi consensus panel was conducted, the experts finalized the recommendations, with a minimum of 75% agreement required. RESULTS: Final recommendations for patients with Sjögren disease with dry mouth were as follows: topical fluoride should be used in all patients (strong); although no study results link improved salivary flow to caries prevention, the oral health community generally accepts that increasing saliva may contribute to decreased caries incidence, so increasing saliva through gustatory, masticatory, or pharmaceutical stimulation may be considered (weak); chlorhexidine administered as varnish, gel, or rinse may be considered (weak); and nonfluoride remineralizing agents may be considered as an adjunct therapy (moderate). CONCLUSIONS AND PRACTICAL IMPLICATIONS: The incidence of caries in patients with Sjögren disease can be reduced with the use of topical fluoride and other preventive strategies.

23 Guideline 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. 2016

Singh, Jasvinder A / Saag, Kenneth G / Bridges, S Louis / Akl, Elie A / Bannuru, Raveendhara R / Sullivan, Matthew C / Vaysbrot, Elizaveta / McNaughton, Christine / Osani, Mikala / Shmerling, Robert H / Curtis, Jeffrey R / Furst, Daniel E / Parks, Deborah / Kavanaugh, Arthur / O'Dell, James / King, Charles / Leong, Amye / Matteson, Eric L / Schousboe, John T / Drevlow, Barbara / Ginsberg, Seth / Grober, James / St Clair, E William / Tindall, Elizabeth / Miller, Amy S / McAlindon, Timothy. ·University of Alabama at Birmingham. · American University of Beirut, Beirut, Lebanon, and McMaster University, Hamilton, Ontario, Canada. · Tufts Medical Center, Boston, Massachusetts. · Beth Israel Deaconess Medical Center, Boston, Massachusetts. · University of California, Los Angeles. · Washington University School of Medicine, St. Louis, Missouri. · University of California, San Diego. · University of Nebraska Medical Center, Omaha. · North Mississippi Medical Center, Tupelo. · Healthy Motivation, Santa Barbara, California. · Mayo Clinic, Rochester, Minnesota. · University of Minnesota and Park Nicollet Clinic, St. Louis Park. · NorthShore University Health System, Evanston, Illinois. · Global Healthy Living Foundation, New York, New York. · Duke University Medical Center, Durham, North Carolina. · Rheumatology Consultants of Oregon, West Linn. · American College of Rheumatology, Atlanta, Georgia. ·Arthritis Rheumatol · Pubmed #26545940.

ABSTRACT: OBJECTIVE: To develop a new evidence-based, pharmacologic treatment guideline for rheumatoid arthritis (RA). METHODS: We conducted systematic reviews to synthesize the evidence for the benefits and harms of various treatment options. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence. We employed a group consensus process to grade the strength of recommendations (either strong or conditional). A strong recommendation indicates that clinicians are certain that the benefits of an intervention far outweigh the harms (or vice versa). A conditional recommendation denotes uncertainty over the balance of benefits and harms and/or more significant variability in patient values and preferences. RESULTS: The guideline covers the use of traditional disease-modifying antirheumatic drugs (DMARDs), biologic agents, tofacitinib, and glucocorticoids in early (<6 months) and established (≥6 months) RA. In addition, it provides recommendations on using a treat-to-target approach, tapering and discontinuing medications, and the use of biologic agents and DMARDs in patients with hepatitis, congestive heart failure, malignancy, and serious infections. The guideline addresses the use of vaccines in patients starting/receiving DMARDs or biologic agents, screening for tuberculosis in patients starting/receiving biologic agents or tofacitinib, and laboratory monitoring for traditional DMARDs. The guideline includes 74 recommendations: 23% are strong and 77% are conditional. CONCLUSION: This RA guideline should serve as a tool for clinicians and patients (our two target audiences) for pharmacologic treatment decisions in commonly encountered clinical situations. These recommendations are not prescriptive, and the treatment decisions should be made by physicians and patients through a shared decision-making process taking into account patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

24 Guideline 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. 2016

Singh, Jasvinder A / Saag, Kenneth G / Bridges, S Louis / Akl, Elie A / Bannuru, Raveendhara R / Sullivan, Matthew C / Vaysbrot, Elizaveta / McNaughton, Christine / Osani, Mikala / Shmerling, Robert H / Curtis, Jeffrey R / Furst, Daniel E / Parks, Deborah / Kavanaugh, Arthur / O'Dell, James / King, Charles / Leong, Amye / Matteson, Eric L / Schousboe, John T / Drevlow, Barbara / Ginsberg, Seth / Grober, James / St Clair, E William / Tindall, Elizabeth / Miller, Amy S / McAlindon, Timothy / Anonymous1780848. ·University of Alabama at Birmingham. · American University of Beirut, Beirut, Lebanon, and McMaster University, Hamilton, Ontario, Canada. · Tufts Medical Center, Boston, Massachusetts. · Beth Israel Deaconess Medical Center, Boston, Massachusetts. · University of California, Los Angeles. · Washington University School of Medicine, St. Louis, Missouri. · University of California, San Diego. · University of Nebraska Medical Center, Omaha. · North Mississippi Medical Center, Tupelo. · Healthy Motivation, Santa Barbara, California. · Mayo Clinic, Rochester, Minnesota. · University of Minnesota and Park Nicollet Clinic, St. Louis Park. · NorthShore University Health System, Evanston, Illinois. · Global Healthy Living Foundation, New York, New York. · Duke University Medical Center, Durham, North Carolina. · Rheumatology Consultants of Oregon, West Linn. · American College of Rheumatology, Atlanta, Georgia. ·Arthritis Care Res (Hoboken) · Pubmed #26545825.

ABSTRACT: OBJECTIVE: To develop a new evidence-based, pharmacologic treatment guideline for rheumatoid arthritis (RA). METHODS: We conducted systematic reviews to synthesize the evidence for the benefits and harms of various treatment options. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence. We employed a group consensus process to grade the strength of recommendations (either strong or conditional). A strong recommendation indicates that clinicians are certain that the benefits of an intervention far outweigh the harms (or vice versa). A conditional recommendation denotes uncertainty over the balance of benefits and harms and/or more significant variability in patient values and preferences. RESULTS: The guideline covers the use of traditional disease-modifying antirheumatic drugs (DMARDs), biologic agents, tofacitinib, and glucocorticoids in early (<6 months) and established (≥6 months) RA. In addition, it provides recommendations on using a treat-to-target approach, tapering and discontinuing medications, and the use of biologic agents and DMARDs in patients with hepatitis, congestive heart failure, malignancy, and serious infections. The guideline addresses the use of vaccines in patients starting/receiving DMARDs or biologic agents, screening for tuberculosis in patients starting/receiving biologic agents or tofacitinib, and laboratory monitoring for traditional DMARDs. The guideline includes 74 recommendations: 23% are strong and 77% are conditional. CONCLUSION: This RA guideline should serve as a tool for clinicians and patients (our two target audiences) for pharmacologic treatment decisions in commonly encountered clinical situations. These recommendations are not prescriptive, and the treatment decisions should be made by physicians and patients through a shared decision-making process taking into account patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

25 Guideline The importance of assessment and management of morning stiffness in Asian patients with rheumatoid arthritis: Recommendations from an expert panel. 2016

Mok, Chi Chiu / Cha, Hoon Suk / Hidayat, Rudy / Nguyen, Lan Thi Ngoc / Perez, Emmanuel C / Ramachandran, Raveendran / Tsay, Gregory J / Yoo, Dae Hyun / Anonymous4900843. ·Department of Medicine, Tuen Mun Hospital, Hong Kong, China. · Sungkyunkwan University, Seoul, South Korea. · Dr Ciptomangunkusumo Hospital, Jakarta, Indonesia. · Hanoi Medical University, Hanoi, Vietnam. · De la Salle University Medical Center, Health Science Institute, Cavite, Philippines. · Sime Darby Medical Centre, Subang Jaya, Malaysia. · Chung Shan Medical University, Taichung, Taiwan. · Hanyang University, Seoul, South Korea. ·Int J Rheum Dis · Pubmed #26403254.

ABSTRACT: OBJECTIVE: In patients with rheumatoid arthritis (RA), morning stiffness is linked more to functional disability and pain than disease activity, as assessed by joint counts and markers of inflammation. As part of the Asia Pacific Morning Stiffness in Rheumatoid Arthritis Expert Panel, a group of eight rheumatologists met to formulate consensus points and develop recommendations for the assessment and management of morning stiffness in RA. METHODS: On the basis of a systematic literature review and expert opinion, a panel of Asian rheumatologists formulated recommendations for the assessment and medical treatment of RA. RESULTS: The panel agreed upon 10 consensus statements on morning stiffness, its assessment and treatment. Specifically, the panel recommended that morning stiffness, pain and impaired morning function should be routinely assessed in clinical practice. Although there are currently no validated tools for these parameters, they should be assessed as part of the patients' reported outcomes in RA. The panel also agreed on the benefits of low-dose glucocorticoids in RA, particularly for the improvement of morning stiffness. CONCLUSIONS: These recommendations serve to guide rheumatologists and other stakeholders on the assessment and management of morning stiffness, and help implement the treat-to-target principle in the management of RA.

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