European League Against Rehumatism [EULAR] releases new guidelines on Rheumatoid Arthritis in EULAR congress; address use of synthetic and biological disease-modifying anti-rheumatic drugs
The European League Against Rheumatism (EULAR) has released updated recommendations for the management of rheumatoid arthritis.
Rheumatoid arthrits is a chronic, inflammatory autoimmune disease that affect approximately 1 in 100 people worldwide.
Rheumatoid arthrits can cause pain, stiffness, progressive joint destruction and deformity, and reduce physical function, workability, quality of life and life expectancy.
In addition, rheumatoid arthrits is associated with a number of co-morbidities, including cardiovascular disease, cancer, lung disease, gastrointestinal disorders and infection.
The guidelines developed by Dr Smolen and colleagues were presented in 2013 EULAR congress and are yet to be published. The updated guidelines stress on treatment with disease-modifying anti-rheumatic drugs as soon as a diagnosis of rheumatoid arthritis is made.
The aim of the treatment is to reach target of remission or low disease activity in every patient.
The recommendations are
- Methotrexate or combination therapy of methotrexate with other conventional synthetic disease-modifying anti-rheumatic drugs should be first line of treatment.
- Low-dose glucocorticoids should also be considered in combination with disease-modifying anti-rheumatic drugs for up to six months, but should be taperedas soon as clinically feasible.
- In patients who fail to respond within 6 months and when poor prognostic factors are present, biological disease-modifying anti-rheumatic drugs (TNF-inhibitors, abatacept or tocilizumab – or under certain circumstances rituximab) should be administered in combination with methotrexte.
- Patients who have failed to respond to an initial biologic disease-modifying anti-rheumatic drugs should receive another biologic disease-modifying anti-rheumatic drugs.
- Patients who have failed to respond to an initial TNF-inhibitor may receive another TNF-inhibitor, or a biologic disease-modifying anti-rheumatic drugs with an alternative mode of action.
- If biologic treatment has failed, tofacitinib may be considered where approved.
Tofacitinib is only recommended after at least one biological has failed.
[Tofacitinib has been approved by the US Food and Drug Administration as well as in Japan and Russia.]
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