EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update

被引：1706

作者：

Smolen, Josef S. ^{[1
,2
]}

Landewe, Robert ^{[3
,4
]}

Breedveld, Ferdinand C. ^{[5
]}

Buch, Maya ^{[6
,7
]}

Burmester, Gerd ^{[8
,9
,10
]}

Dougados, Maxime ^{[11
]}

Emery, Paul ^{[6
,7
]}

Gaujoux-Viala, Cecile ^{[12
]}

Gossec, Laure ^{[13
]}

Nam, Jackie ^{[6
,7
]}

Ramiro, Sofia ^{[3
,14
]}

Winthrop, Kevin ^{[15
]}

de Wit, Maarten ^{[16
]}

Aletaha, Daniel ^{[1
]}

Betteridge, Neil ^{[16
]}

Bijlsma, Johannes W. J. ^{[17
]}

Boers, Maarten ^{[18
]}

Buttgereit, Frank ^{[8
,9
,10
]}

Combe, Bernard ^{[19
]}

Cutolo, Maurizio ^{[20
]}

Damjanov, Nemanja ^{[21
]}

Hazes, Johanna M. W. ^{[22
]}

Kouloumas, Marios ^{[16
]}

Kvien, Tore K. ^{[23
]}

Mariette, Xavier ^{[24
,25
]}

Pavelka, Karel ^{[26
,27
]}

van Riel, Piet L. C. M. ^{[28
]}

Rubbert-Roth, Andrea ^{[29
]}

Scholte-Voshaar, Marieke ^{[16
]}

Scott, David L. ^{[30
]}

Sokka-Isler, Tuulikki ^{[31
,32
]}

Wong, John B. ^{[33
]}

van der Heijde, Desiree ^{[5
]}

机构：

[1] Med Univ Vienna, Div Rheumatol, Dept Med 3, Waehringer Guertel 18-20, A-1090 Vienna, Austria

[2] Hietzing Hosp Vienna, Dept Med 2, Vienna, Austria

[3] Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands

[4] Atrium Med Ctr, Heerlen, Netherlands

[5] Leiden Univ, Med Ctr, Dept Rheumatol, Leiden, Netherlands

[6] Univ Leeds, Chapel Allerton Hosp, Leeds Inst Rheumat & Musculoskeletal Med, Leeds, W Yorkshire, England

[7] Leeds Teaching Hosp NHS Trust, NIHR Leeds Musculoskeletal Biomed Res Unit, Leeds, W Yorkshire, England

[8] Free Univ Berlin, Charite Univ Med, Dept Rheumatol & Clin Immunol, Berlin, Germany

[9] Humboldt Univ, D-10099 Berlin, Germany

[10] Clin Immunol Free Univ, Berlin, Germany

[11] Rene Descartes Univ, Cochin Hosp, Dept Rheumatol B, Paris, France

[12] Univ Montpellier I, Dept Rheumatol, Nimes Univ Hosp, Nimes, France

[13] Univ Paris 06, Pite Salpetriere Hosp, AP HP, Dept Rheumatol, Paris, France

[14] Hosp Garcia de Orta, Almada, Portugal

[15] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[16] EULAR Standing Comm People Arthrit Rheumatism Eur, Zurich, Switzerland

[17] Univ Med Ctr Utrecht, Dept Rheumatol & Clin Immunol, Utrecht, Netherlands

[18] Vrije Univ Amsterdam Med Ctr, Amsterdam, Netherlands

[19] Univ Montpellier, Lapeyronie Hosp, Serv Immunorhumatol, F-34059 Montpellier, France

[20] Univ Genoa, Dept Internal Med, Acad Clin Unit Rheumatol, I-16126 Genoa, Italy

[21] Univ Belgrade, Sch Med, Inst Rheumatol, Hosp Dept 2, Belgrade, Serbia

[22] Univ Med Ctr, Erasmus MC, Dept Rheumatol, Rotterdam, Netherlands

[23] Diakonhjemmet Hosp, Dept Rheumatol, Oslo, Norway

[24] Hop Univ Paris Sud, AP HP, Le Kremlin Bicetre, France

[25] Univ Paris 11, Le Kremlin Bicetre, France

[26] Charles Univ Prague, Inst Rheumatol, Prague, Czech Republic

[27] Charles Univ Prague, Clin Rheumatol, Prague, Czech Republic

[28] Radboud Univ Nijmegen, Med Ctr, Dept Rheumatol, NL-6525 ED Nijmegen, Netherlands

[29] Univ Cologne, Dept Internal Med, D-50931 Cologne, Germany

[30] Weston Educ Ctr, Kings Coll Sch Med, London, England

[31] Jyvaskyla Cent Hosp, Jyvaskyla, Finland

[32] Medcare Oy, Aanekoski, Finland

[33] Tufts Univ, Sch Med, Div Clin Decis Making Informat & Telemed, Boston, MA 02111 USA

来源：

ANNALS OF THE RHEUMATIC DISEASES | 2014年 / 73卷 / 03期

关键词：

Rheumatoid Arthritis; DMARDs (synthetic); DMARDs (biologic); Treatment; Early Rheumatoid Arthritis; ADALIMUMAB PLUS METHOTREXATE; RAPID RADIOGRAPHIC PROGRESSION; LOW-DOSE PREDNISOLONE; DOUBLE-BLIND; COMBINATION THERAPY; JOINT DAMAGE; TREATMENT STRATEGIES; INADEQUATE RESPONSE; PARALLEL-GROUP; FOLLOW-UP;

D O I：

10.1136/annrheumdis-2013-204573

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

In this article, the 2010 European League against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) with synthetic and biological disease-modifying antirheumatic drugs (sDMARDs and bDMARDs, respectively) have been updated. The 2013 update has been developed by an international task force, which based its decisions mostly on evidence from three systematic literature reviews (one each on sDMARDs, including glucocorticoids, bDMARDs and safety aspects of DMARD therapy); treatment strategies were also covered by the searches. The evidence presented was discussed and summarised by the experts in the course of a consensus finding and voting process. Levels of evidence and grades of recommendations were derived and levels of agreement (strengths of recommendations) were determined. Fourteen recommendations were developed (instead of 15 in 2010). Some of the 2010 recommendations were deleted, and others were amended or split. The recommendations cover general aspects, such as attainment of remission or low disease activity using a treat-to-target approach, and the need for shared decision-making between rheumatologists and patients. The more specific items relate to starting DMARD therapy using a conventional sDMARD (csDMARD) strategy in combination with glucocorticoids, followed by the addition of a bDMARD or another csDMARD strategy (after stratification by presence or absence of adverse risk factors) if the treatment target is not reached within 6months (or improvement not seen at 3months). Tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, biosimilars), abatacept, tocilizumab and, under certain circumstances, rituximab are essentially considered to have similar efficacy and safety. If the first bDMARD strategy fails, any other bDMARD may be used. The recommendations also address tofacitinib as a targeted sDMARD (tsDMARD), which is recommended, where licensed, after use of at least one bDMARD. Biosimilars are also addressed. These recommendations are intended to inform rheumatologists, patients, national rheumatology societies and other stakeholders about EULAR's most recent consensus on the management of RA with sDMARDs, glucocorticoids and bDMARDs. They are based on evidence and expert opinion and intended to improve outcome in patients with RA.

引用

页码：492 / 509

页数：18

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