ACR Releases New Rheumatoid Arthritis Guidelines
The American College of Rheumatology (ACR) has released an updated set of guidelines for the treatment of rheumatoid arthritis (RA), which include recommendations on drug therapies, treat-to-target approaches, and vaccinations.
The new guidelines—which include 74 recommendations, 23% strong and 77% conditional—are designed to guide patients and physicians in discussing evidence-based treatment options to determine the best care for RA.
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Recommendations on commonly encountered clinical situations include:1,2
- Use of disease-modifying antirheumatic drugs (DMARDs), biologics, tofacitinib, and glucocorticoids in patients with RA
- Recommendations on using a treat-to-target approach as well as tapering and discontinuing medications
- Use of biologics and DMARDs in high-risk RA patients with comorbidities (eg, heptatitis, congestive heart failure, malignancy and serious infections)
- Use of vaccines in patients starting or receiving DMARDs or biologics
- Screening for tuberculosis in patients starting or receiving biologics or tofacitinib
- Laboratory monitoring for traditional DMARDs
Jasvinder Singh, MD, MPH, a rheumatologist at the University of Alabama who served as principal investigator for the guideline project said that the new guideline was developed using the GUIDE (grading of recommendations assessment, development, and evaluation) methodology.
“Important features of the GRADE method include the very clear specification of patient groups, interventions, competing treatment alternatives and outcomes; grading the quality of the evidence used; and basing recommendation strength on evidence quality, balance of benefits and harms, patient preference of treatment options, as well as clinical experience and expertise,” ACR noted.
The complete guidelines were simultaneously published in Arthritis and Rheumatology and Arthritis Care & Research.
- Singh J, Saag K, Bridges SL, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Art Rheum. 2015 Nov 6 [epub ahead of print].
- American College of Rheumatology. 2015 ACR guideline for the treatment of rheumatoid arthritis now available online [press release]. November 10, 2015. www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/720/2015-ACR-Guideline-for-the-Treatment-of-Rheumatoid-Arthritis-Now-Available-Online. Accessed November 13, 2015.