Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Rheumatoid Arthritis HELP
Based on 30,279 articles published since 2008
||||

These are the 30279 published articles about Arthritis, Rheumatoid that originated from Worldwide during 2008-2018.
 
+ 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 Inflammatory arthritis or osteoarthritis of the knee - Efficacy of intra-joint infiltration of methylprednisolone acetate versus triamcinolone acetonide or triamcinolone hexacetonide. 2017

Anonymous3111127 / Silvinato, Antonio / Bernardo, Wanderley Marques. ·Associação Médica Brasileira (AMB). ·Rev Assoc Med Bras (1992) · Pubmed #29267483.

ABSTRACT: -- No abstract --

2 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 / Anonymous1991133. ·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 --

3 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 / Anonymous1981133. ·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 --

4 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.

5 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.

6 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.

7 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.

8 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.

9 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 / Anonymous3761007. ·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.

10 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 / Anonymous751064. ·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.

11 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.

12 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 / Anonymous1331165. ·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.

13 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.

14 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 / Anonymous510855. · ·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.

15 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.

16 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 / Anonymous151181. ·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.

17 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 / Anonymous5770843. ·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.

18 Guideline Update on the 2012 Brazilian Society of Rheumatology Guidelines for the treatment of rheumatoid arthritis: position on the use of tofacitinib. 2015

da Mota, Licia Maria Henrique / Cruz, Bóris Afonso / de Albuquerque, Cleandro Pires / Gonçalves, Deborah Pereira / Laurindo, Ieda Maria Magalhães / Pereira, Ivanio Alves / de Carvalho, Jozélio Freire / Pinheiro, Geraldo da Rocha Castelar / Bertolo, Manoel Barros / Pinto, Maria Raquel da Costa / Louzada-Junior, Paulo / Xavier, Ricardo Machado / Giorgi, Rina Dalva Neubarth / Lima, Rodrigo Aires Corrêa. ·Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, DF, Brasil; Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, DF, Brasil. Electronic address: licia@unb.br. · Biocor Instituto, Nova Lima, MG, Brasil. · Serviço de Reumatologia, Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, DF, Brasil. · Serviço de Reumatologia, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil; Serviço de Reumatologia, Hospital Geral Dr. César Cals, Fortaleza, CE, Brasil; Programa de Residência Médica em Reumatologia, Hospital Geral Dr. César Cals, Fortaleza, CE, Brasil. · Universidade de São Paulo (USP), São Paulo, SP, Brasil; BiobadaBrasil, Brasil. · Disciplina de Reumatologia, Universidade do Sul de Santa Catarina (Unisul), Florianópolis, SC, Brasil; Núcleo de Reumatologia, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil. · Hospital Aliança, Salvador, BA, Brasil. · Disciplina de Reumatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (Uerj), Rio de Janeiro, RJ, Brasil. · Disciplina de Reumatologia, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil; Departamento de Clínica Médica, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil. · Ambulatório de Artrite Reumatoide, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil; Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil. · Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brasil. · Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil; Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil. · Serviço de Reumatologia, Hospital do Servidor Público Estadual Francisco Morato de Oliveira (HSPE-FMO), São Paulo, SP, Brasil. · Serviço de Reumatologia, Hospital de Base do Distrito Federal, Brasília, DF, Brasil. ·Rev Bras Reumatol · Pubmed #26456224.

ABSTRACT: In 2014, tofacitinib, a target-specific, synthetic disease modifying anti rheumatic drug (DMARD) and a selective inhibitor of Janus kinase (JAK) was approved for use in Brazil. This position paper aims to update the recommendations of the Brazilian Society of Rheumatology (SBR) on the treatment of rheumatoid arthritis (RA) in Brazil, specifically regarding the use of target-specific synthetic DMARDs. The method of this recommendation consisted of a literature review of scientific papers held on the Medline database. After this review, a text was produced, answering questions in Pico structure, considering efficacy and safety issues of tofacitinib use for RA treatment in different scenarios (such as first-line treatment after failure with methotrexate [MTX] or other conventional synthetic DMARDs after failure with biological therapy). Based on existing evidence, and considering the available data on efficacy, safety and cost of medications available to treat the disease in Brazil, the RA Commission of SBR, after a process of discussion and voting on proposals, established the following position on the use of tofacitinib for treatment of RA in Brazil: "Tofacitinib, alone or in combination with MTX, is an alternative for RA patients with moderate or high activity after failure of at least two different synthetic DMARDs and one biological DMARD." The level of agreement with this recommendation was 7.5. This position may be reviewed in the coming years, in the face of a greater experience with the use of this medication.

19 Guideline Recommendations for the treatment of Sjögren's syndrome. 2015

Valim, Valéria / Trevisani, Virgínia Fernandes Moça / Pasoto, Sandra Gofinet / Serrano, Erica Vieira / Ribeiro, Sandra Lúcia Euzébio / Fidelix, Tania Sales de Alencar / Vilela, Verônica Silva / Prado, Leandro Lara do / Tanure, Leandro Augusto / Libório-Kimura, Tatiana Nayara / Brito Filho, Odvaldo Honor de / Barros, Liliana Aparecida Pimenta de / Miyamoto, Samira Tatiyama / Lourenço, Silvia Vanessa / Santos, Maria Carmen Lopes Ferreira Silva / Vieira, Luis Antonio / Adán, Consuelo Bueno Diniz / Bernardo, Wanderley Marques. ·Hospital Universitário Cassiano Antônio de Moraes (Hucam), Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Clínica Médica, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo (Ufes), Vitória, ES, Brasil. Electronic address: val.valim@gmail.com. · Departamento de Clínica Médica, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil; Disciplina de Reumatologia, Universidade de Santo Amaro (Unisa), São Paulo, SP, Brasil. · Hospital das Clínicas, Faculdade de Medicina, Departamento de Clínica Médica, Divisão de Reumatologia, Universidade de São Paulo (USP), São Paulo, SP, Brasil. · Hospital Universitário Cassiano Antônio de Moraes (Hucam), Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Espírito Santo (Ufes), Vitória, ES, Brasil; Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (Emescam), Vitória, ES, Brasil. · Departamento de Clínica Médica/Reumatologia, Universidade Federal do Amazonas (Ufam), Manaus, AM, Brasil. · Departamento de Clínica Médica, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil. · Disciplina de Reumatologia, Universidade do Estado do Rio de Janeiro (Uerj), Rio de Janeiro, RJ, Brasil. · Departamento do Aparelho Locomotor, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil. · Departamento de Patologia e Medicina Legal, Faculdade de Medicina, Universidade Federal do Amazonas (Ufam), Manaus, AM, Brasil. · Cirurgião-dentista e Periodontista. · Departamento de Clínica Odontológica, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo (Ufes), Vitória, ES, Brasil. · Departamento de Educação Integrada em Saúde, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo (Ufes), Vitória, ES, Brasil. · Disciplina de Patologia Geral, Faculdade de Odontologia, Universidade de São Paulo (USP), São Paulo, SP, Brasil. · Departamento de Patologia, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo (Ufes), Vitória, ES, Brasil. · Departamento de Oftalmologia da Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil. · Projeto Diretrizes, Associação Médica Brasileira (AMB), São Paulo, SP, Brasil. ·Rev Bras Reumatol · Pubmed #26360421.

ABSTRACT: The recommendations proposed by the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology for the treatment of Sjögren's syndrome were based on a systematic review of literature in Medline (PubMed) and the Cochrane databases until October 2014 and on expert opinion in the absence of studies on the subject. 131 items classified according to Oxford & Grade were included. These recommendations were developed in order to guide the appropriate management and facilitate the access to treatment for those patients with an appropriate indication, considering the Brazilian socioeconomic context and pharmacological agents available in this country.

20 Guideline APLAR rheumatoid arthritis treatment recommendations. 2015

Lau, Chak Sing / Chia, Faith / 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 / Nash, Peter / Ng, Chin Teck / Park, Sung-Hwan / Suryana, Bagus Putu Putra / Suwannalai, Parawee / Wijaya, Linda Kurniaty / Yamamoto, Kazuhiko / Yang, Yue / Yeap, Swan Sim / Anonymous6180841. ·Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, University of Hong Kong, Hong Kong. · Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore City, Singapore. · Department of Medicine, University of Otago Wellington, Wellington South, New Zealand. · Section of Allergy, Immunology and Rheumatology, and Section of Clinical Skills Training, Taichung Veterans General Hospital, Taichung, Taiwan. · Narayana Hospital, Jaipur, India. · Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, St. Mary's Hospital, Seoul, South Korea. · Immuno-Rheumatology Center, St Luke's International Hospital, Tokyo, Japan. · Department of Rheumatology, Fortis Flt. Lt Rajan Dhall Hospital, New Delhi, India. · Department of Rheumatology, Peking University People's Hospital, Beijing, China. · 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 and Immunology, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan. · Department of Medicine, University of Queensland, Brisbane, Queensland, Australia. · Department of Rheumatology and Immunology, Singapore General Hospital, Singapore City, Singapore. · Rheumatology Division, Department of Internal Medicine, Brawijaya University, Saiful Anwar General Hospital, Malang, Indonesia. · Allergy, Immunology and Rheumatology Division, Internal Medicine Department, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. · Division of Rheumatology, Department of Internal Medicine, University of Indonesia, Jakarta, Indonesia. · Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. · Subang Jaya Medical Centre, Selangor, Malaysia. ·Int J Rheum Dis · Pubmed #26334449.

ABSTRACT: AIMS: Rheumatoid arthritis is a chronic inflammatory condition that affects approximately 1% of the world's population. There are a wide number of guidelines and recommendations available to support the treatment of rheumatoid arthritis; however, the evidence used for these guidelines is predominantly based on studies in Caucasian subjects and may not be relevant for rheumatoid arthritis patients in the Asia-Pacific region. Therefore, the Asia Pacific League of Associations for Rheumatology established a Steering Committee in 2013 to address this issue. MATERIALS AND METHODS: The AGREE II instrument and the ADAPTE Collaboration framework were applied to systematically identify, appraise, synthesize, and adapt international rheumatoid arthritis guidelines for use in the Asia-Pacific region. RESULTS: Forty rheumatoid arthritis treatment recommendations, based on evidence and expert opinion, were drafted and are presented in this report. CONCLUSION: The Asia Pacific of Associations for Rheumatology rheumatoid arthritis treatment recommendations are intended to serve as a reference for best practice management of rheumatoid arthritis in Asia-Pacific, focusing on local issues to ensure the delivery of basic care for these patients, and to improve their outcomes. In addition, the document will serve as a reference for national rheumatology associations in Asia-Pacific for developing guidelines in their respective countries.

21 Guideline [Preliminary guidelines of the Brazilian Society of Rheumatology for evaluation and treatment of tuberculosis latent infection in patients with rheumatoid arthritis, in face of unavailability of the tuberculin skin test]. 2015

da Mota, Licia Maria Henrique / Cruz, Bóris Afonso / de Albuquerque, Cleandro Pires / Gonçalves, Deborah / Laurindo, Ieda Maria Magalhães / Pereira, Ivanio Alves / de Carvalho, Jozélio Freire / Pinheiro, Geraldo da Rocha Castelar / Bertolo, Manoel Barros / da Silva, Nilzio Antônio / Louzada Júnior, Paulo / Xavier, Ricardo Machado / Giorgi, Rina Dalva Neubarth / Lima, Rodrigo Aires Corrêa. ·Sociedade Brasileira de Reumatologia, São Paulo, SP, Brasil. Electronic address: liciamhmota@gmail.com. · Sociedade Brasileira de Reumatologia, São Paulo, SP, Brasil. ·Rev Bras Reumatol · Pubmed #26165801.

ABSTRACT: -- No abstract --

22 Guideline 2014 update of the Consensus Statement of the Spanish Society of Rheumatology on the use of biological therapies in rheumatoid arthritis. 2015

Sanmartí, Raimon / García-Rodríguez, Susana / Álvaro-Gracia, José María / Andreu, José Luis / Balsa, Alejandro / Cáliz, Rafael / Fernández-Nebro, Antonio / Ferraz-Amaro, Iván / Gómez-Reino, Juan Jesús / González-Álvaro, Isidoro / Martín-Mola, Emilio / Martínez-Taboada, Víctor Manuel / Ortiz, Ana M / Tornero, Jesús / Marsal, Sara / Moreno-Muelas, José Vicente. ·Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España. Electronic address: sanmarti@clinic.ub.es. · Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España. · Servicio de Reumatología, Hospital Universitario de la Princesa, Madrid, España. · Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Madrid, España. · Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España. · Servicio de Reumatología, Hospital Universitario Virgen de las Nieves, Granada, España. · Unidad de Gestión Clínica de Reumatología, Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, España. · Servicio de Reumatología, Hospital Universitario de Canarias, Tenerife, España. · Servicio de Reumatología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España. · Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España. · Servicio de Reumatología, Hospital Universitario de Guadalajara, Guadalajara, España. · Servicio de Reumatología, Hospital Universitario Vall d́Hebron, Barcelona, España. · Servicio de Reumatología, Hospital Universitario Vall d́Hebron, Barcelona, España; Sociedad Española de Reumatología, Madrid, España. ·Reumatol Clin · Pubmed #26051464.

ABSTRACT: OBJECTIVE: To establish recommendations for the management of patients with rheumatoid arthritis (RA) to serve as a reference for all health professionals involved in the care of these patients, and focusing on the role of available synthetic and biologic disease-modifying antirheumatic drugs (DMARDs). METHODS: Consensual recommendations were agreed on by a panel of 14 experts selected by the Spanish Society of Rheumatology (SER). The available scientific evidence was collected by updating three systematic reviews (SR) used for the EULAR 2013 recommendations. A new SR was added to answer an additional question. The literature review of the scientific evidence was made by the SER reviewer's group. The level of evidence and the degree of recommendation was classified according to the Oxford Centre for Evidence-Based Medicine system. A Delphi panel was used to evaluate the level of agreement between panellists (strength of recommendation). RESULTS: Thirteen recommendations for the management of adult RA were emitted. The therapeutic objective should be to treat patients in the early phases of the disease with the aim of achieving clinical remission, with methotrexate playing a central role in the therapeutic strategy of RA as the reference synthetic DMARD. Indications for biologic DMARDs were updated and the concept of the optimization of biologicals was introduced. CONCLUSIONS: We present the fifth update of the SER recommendations for the management of RA with synthetic and biologic DMARDs.

23 Guideline EULAR recommendations for patient education for people with inflammatory arthritis. 2015

Zangi, Heidi A / Ndosi, Mwidimi / Adams, Jo / Andersen, Lena / Bode, Christina / Boström, Carina / van Eijk-Hustings, Yvonne / Gossec, Laure / Korandová, Jana / Mendes, Gabriel / Niedermann, Karin / Primdahl, Jette / Stoffer, Michaela / Voshaar, Marieke / van Tubergen, Astrid / Anonymous4980822. ·Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · School of Healthcare, University of Leeds, Leeds, UK and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. · Centre for Innovation and Leadership in Health Faculty of Health Sciences University of Southampton Highfield, Southampton, UK. · Nyborg, Denmark. · Department of Psychology, University of Twente, Health & Technology, Enschede, The Netherlands. · Division of physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. · Department of Patient & Care/ Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands CAPHRI, School for Public Health and Primary Care, University of Maastricht, Maastricht, The Netherlands. · Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France Department of rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France. · Institute of Rheumatology, Prague, Czech Republic. · Department of National Team, Portuguese Cycling Federation, Lisbon, Portugal. · Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland. · Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark Hospital of Southern Jutland, Aabenraa, Denmark King Christian X's Hospital for Rheumatic Diseases, Graasten, Denmark. · Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria. · Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands. · Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands. ·Ann Rheum Dis · Pubmed #25735643.

ABSTRACT: OBJECTIVES: The task force aimed to: (1) develop evidence-based recommendations for patient education (PE) for people with inflammatory arthritis, (2) identify the need for further research on PE and (3) determine health professionals' educational needs in order to provide evidence-based PE. METHODS: A multidisciplinary task force, representing 10 European countries, formulated a definition for PE and 10 research questions that guided a systematic literature review (SLR). The results from the SLR were discussed and used as a basis for developing the recommendations, a research agenda and an educational agenda. The recommendations were categorised according to level and strength of evidence graded from A (highest) to D (lowest). Task force members rated their agreement with each recommendation from 0 (total disagreement) to 10 (total agreement). RESULTS: Based on the SLR and expert opinions, eight recommendations were developed, four with strength A evidence. The recommendations addressed when and by whom PE should be offered, modes and methods of delivery, theoretical framework, outcomes and evaluation. A high level of agreement was achieved for all recommendations (mean range 9.4-9.8). The task force proposed a research agenda and an educational agenda. CONCLUSIONS: The eight evidence-based and expert opinion-based recommendations for PE for people with inflammatory arthritis are intended to provide a core framework for the delivery of PE and training for health professionals in delivering PE across Europe.

24 Guideline Clinical practice guidelines for the management of pregnancy in women with autoimmune rheumatic diseases of the Mexican College of Rheumatology. Part II. 2015

Saavedra Salinas, Miguel Ángel / Barrera Cruz, Antonio / Cabral Castañeda, Antonio Rafael / Jara Quezada, Luis Javier / Arce-Salinas, C Alejandro / Álvarez Nemegyei, José / Fraga Mouret, Antonio / Orozco Alcalá, Javier / Salazar Páramo, Mario / Cruz Reyes, Claudia Verónica / Andrade Ortega, Lilia / Vera Lastra, Olga Lidia / Mendoza Pinto, Claudia / Sánchez González, Antonio / Cruz Cruz, Polita Del Rocío / Morales Hernández, Sara / Portela Hernández, Margarita / Pérez Cristóbal, Mario / Medina García, Gabriela / Hernández Romero, Noé / Velarde Ochoa, María Del Carmen / Navarro Zarza, José Eduardo / Portillo Díaz, Verónica / Vargas Guerrero, Angélica / Goycochea Robles, María Victoria / García Figueroa, José Luis / Barreira Mercado, Eduardo / Amigo Castañeda, Mary Carmen. ·Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza, IMSS, UNAM, México, Distrito Federal, México. Electronic address: miansaavsa@gmail.com. · División de Excelencia Clínica, Área de Desarrollo de Guías de Práctica Clínica, IMSS, México, Distrito Federal, México. · Ciencias Médicas F, Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Distrito Federal, México. · Dirección de Educación e Investigación, Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza, IMSS, UNAM, México, Distrito Federal, México. · División de Medicina Interna, Hospital Central Sur de Pemex, México, Distrito Federal, México. · Escuela de Medicina, Universidad Anáhuac-Mayab, Mérida, Yucatán, México. · Dirección de Educación e Investigación, Secretaría de Salud del Distrito Federal, UNAM, México, Distrito Federal, México. · Clínica de Reumatología, Escuela de Medicina, Universidad de Guadalajara. Guadalajara, Jalisco, México. · División de Investigación en Salud, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente, IMSS, Centro Universitario Ciencias de la Salud, Universidad de Guadalajara. Guadalajara, Jalisco, México. · Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza, IMSS, México, Distrito Federal, México. · Departamento de Reumatología, Centro Médico Nacional 20 de Noviembre, ISSSTE. UNAM, México, Distrito Federal, México. · Departamento de Medicina Interna, Hospital de Especialidades, CMN La Raza, IMSS, UNAM, México, Distrito Federal, México. · Unidad de Investigación Enfermedades Autoinmunes Sistémicas, Hospital General Regional No. 36-CIBIOR, Instituto Mexicano del Seguro Social. Unidad de Posgrado, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, Puebla, México. · División de Atención Ginecoobstétrica y Perinatal de la Dirección de Prestaciones Médicas del IMSS, México, Distrito Federal, México. · Departamento de Perinatología, Hospital Gineco-Obstetricia No. 3 Dr. Víctor Manuel Espinosa de los Reyes Sánchez. UMAE, CMN La Raza, México, Distrito Federal, México. · Departamento de Reumatología, Hospital de Especialidades, CMN Siglo XXI, IMSS, México, Distrito Federal, México. · Hospital de Especialidades, CMN La Raza, IMSS, México, Distrito Federal, México. · Unidad de Cuidados Intensivos Neonatales. Hospital Gineco-Obstetricia No. 3 Dr. Víctor Manuel Espinosa de los Reyes Sánchez. UMAE, CMN La Raza, México, Distrito Federal, México. · Departamento de Reumatología e Inmunología Clínica, Hospital General de Zona No. 46, IMSS, Villahermosa, Tabasco, México. · Hospital General de Chilpancingo Dr. Raymundo Abarca Alarcón, Chilpancingo, Guerrero, México. · Departamento de Medicina Interna, UMAE HGO 4, IMSS, México, Distrito Federal, México. · Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, México, Distrito Federal, México. · Unidad de Investigación en Epidemiología Clínica, Hospital Regional Dr. Carlos Mcgregor Sánchez Navarro, IMSS, México, Distrito Federal, México. · Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México. · Reumatología, Facultad de Medicina, Universidad Autónoma de Querétaro y Universidad del Valle de México. Querétaro, Qro., México. · Reumatología, Centro Médico ABC, México, Distrito Federal, México. ·Reumatol Clin · Pubmed #25683368.

ABSTRACT: BACKGROUND: Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. OBJECTIVES: To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus, rheumatoid arthritis (RA) and antiphospholipid syndrome (APS). METHODOLOGY: Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and staging of recommendations, internal validation by peers and external validation of the final document. The quality criteria of the AGREE II instrument were followed. RESULTS: The panels answered 37 questions related to maternal and fetal care in lupus erythematosus, RA and APS, as well as for use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. In this second part, the recommendations for pregnant women with RA, APS and the use of antirheumatic drugs during pregnancy and lactation are presented. CONCLUSIONS: We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with RA and APS integrate the best available evidence for the treatment and follow-up of patients with these conditions.

25 Guideline Clinical practice guidelines for the management of pregnancy in women with autoimmune rheumatic diseases of the Mexican College of Rheumatology. Part I. 2015

Saavedra Salinas, Miguel Ángel / Barrera Cruz, Antonio / Cabral Castañeda, Antonio Rafael / Jara Quezada, Luis Javier / Arce-Salinas, C Alejandro / Álvarez Nemegyei, José / Fraga Mouret, Antonio / Orozco Alcalá, Javier / Salazar Páramo, Mario / Cruz Reyes, Claudia Verónica / Andrade Ortega, Lilia / Vera Lastra, Olga Lidia / Mendoza Pinto, Claudia / Sánchez González, Antonio / Cruz Cruz, Polita Del Rocío / Morales Hernández, Sara / Portela Hernández, Margarita / Pérez Cristóbal, Mario / Medina García, Gabriela / Hernández Romero, Noé / Velarde Ochoa, María Del Carmen / Navarro Zarza, José Eduardo / Portillo Díaz, Verónica / Vargas Guerrero, Angélica / Goycochea Robles, María Victoria / García Figueroa, José Luis / Barreira Mercado, Eduardo / Amigo Castañeda, Mary Carmen. ·Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza, IMSS; UNAM, México, Distrito Federal, México. Electronic address: miansaavsa@gmail.com. · División de Excelencia Clínica, Área de Desarrollo de Guías de Práctica Clínica, IMSS, México, Distrito Federal, México. · Ciencias Médicas F, Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Distrito Federal, México. · Dirección de Educación e Investigación, Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza, IMSS, UNAM, México, Distrito Federal, México. · División de Medicina Interna, Hospital Central Sur de Pemex, México, Distrito Federal, México. · Escuela de Medicina, Universidad Anáhuac-Mayab, Mérida, Yucatán, México. · Dirección de Educación e Investigación, Secretaría de Salud del Distrito Federal, UNAM, México, Distrito Federal, México. · Clínica de Reumatología, Escuela de Medicina, Universidad de Guadalajara, Guadalajara, Jalisco, México. · División de Investigación en Salud, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente, IMSS, Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México. · Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza, IMSS; UNAM, México, Distrito Federal, México. · Departamento de Reumatología, Centro Médico Nacional 20 de Noviembre, ISSSTE, Reumatología, UNAM, México, Distrito Federal, México. · Departamento de Medicina Interna, Hospital de Especialidades, CMN La Raza, IMSS, UNAM, México, Distrito Federal, México. · Unidad de Investigación Enfermedades Autoinmunes Sistémicas, Hospital General Regional n.(o) 36-CIBIOR, Instituto Mexicano del Seguro Social. Unidad de Posgrado, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, Puebla, México. · División de Atención Ginecobstétrica y Perinatal de la Dirección de Prestaciones Médicas del IMSS, México, Distrito Federal, México. · Departamento de Perinatología, Hospital Gineco-Obstetricia n.(o)3 Dr. Víctor Manuel Espinosa de los Reyes Sánchez, UMAE, CMN La Raza, IMSS, México, Distrito Federal, México. · Departamento de Reumatología, Hospital de Especialidades, CMN Siglo XXI, IMSS, México, Distrito Federal, México. · Hospital de Especialidades, CMN La Raza, IMSS, México, Distrito Federal, México. · Unidad de Cuidados Intensivos Neonatales, Hospital Gineco-Obstetricia n.(o) 3 Dr. Víctor Manuel Espinosa de los Reyes Sánchez, UMAE, CMN La Raza, IMSS, México, Distrito Federal, México. · Departamento de Reumatología e Inmunología Clínica, Hospital General de Zona No. 46, IMSS, Villahermosa, Tabasco, México. · Hospital General de Chilpancingo Dr. Raymundo Abarca Alarcón, Chilpancingo, Guerrero, México. · Departamento de Medicina Interna, UMAE HGO 4, IMSS, México, Distrito Federal, México. · Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, México, Distrito Federal, México. · Unidad de investigación en Epidemiología Clínica, Hospital Regional Dr. Carlos Mcgregor Sánchez Navarro, IMSS, México, Distrito Federal, México. · Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México. · Reumatología de la Facultad de Medicina, Universidad Autónoma de Querétaro y Universidad del Del Valle de México, Querétaro, Qro., México. · Reumatología, Centro Médico ABC, México, Distrito Federal, México. ·Reumatol Clin · Pubmed #25639457.

ABSTRACT: BACKGROUND: Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. OBJECTIVES: To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus (SLE), rheumatoid arthritis (RA) and antiphospholipid antibody syndrome (APS). METHODOLOGY: Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and grading of recommendations, internal validation by peers, and external validation of the final document. The quality criteria of the AGREE II instrument were followed. RESULTS: The various panels answered the 37 questions related to maternal and fetal care in SLE, RA, and APS, as well as to the use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. We present the recommendations for pregnant women with SLE in this first part. CONCLUSIONS: We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with SLE integrate the best available evidence for the treatment and follow-up of patients with these conditions.

Next