EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update

被引：2143

作者：

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

Landewe, Robert ^{[3
,4
]}

Bijlsma, Johannes ^{[5
]}

Burmester, Gerd ^{[6
,7
,8
]}

Chatzidionysiou, Katerina ^{[9
]}

Dougados, Maxime ^{[10
]}

Nam, Jackie ^{[11
,12
]}

Ramiro, Sofia ^{[13
]}

Voshaar, Marieke ^{[14
]}

van Vollenhoven, Ronald ^{[3
]}

Aletaha, Daniel ^{[1
]}

Aringer, Martin ^{[15
]}

Boers, Maarten ^{[16
]}

Buckley, Chris D. ^{[17
]}

Buttgereit, Frank ^{[6
,7
,8
]}

Bykerk, Vivian ^{[18
,19
]}

Cardiel, Mario ^{[20
]}

Combe, Bernard ^{[21
]}

Cutolo, Maurizio ^{[22
,23
]}

van Eijk-Hustings, Yvonne ^{[24
,25
]}

Emery, Paul ^{[13
]}

Finckh, Axel ^{[26
]}

Gabay, Cem ^{[26
]}

Gomez-Reino, Juan ^{[27
]}

Gossec, Laure ^{[28
]}

Gottenberg, Jacques-Eric ^{[29
,30
]}

Hazes, Johanna M. W. ^{[31
]}

Huizinga, Tom ^{[14
]}

Jani, Meghna ^{[32
]}

Karateev, Dmitry ^{[33
]}

Kouloumas, Marios ^{[34
,35
]}

Kvien, Tore ^{[36
]}

Li, Zhanguo ^{[37
]}

Mariette, Xavier ^{[38
]}

McInnes, Iain ^{[39
]}

Mysler, Eduardo ^{[40
]}

Nash, Peter ^{[41
]}

Pavelka, Karel ^{[42
]}

Poor, Gyula ^{[43
]}

Richez, Christophe ^{[44
]}

van Riel, Piet ^{[45
]}

Rubbert-Roth, Andrea ^{[46
]}

Saag, Kenneth ^{[47
]}

da Silva, Jose ^{[48
]}

Stamm, Tanja ^{[49
]}

Takeuchi, Tsutomu ^{[50
]}

Westhovens, Rene ^{[51
,52
]}

de Wit, Maarten ^{[53
,54
]}

van der Heijde, Desiree ^{[13
]}

机构：

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

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

[3] Amsterdam Rheumatol & Immunol Ctr, Amsterdam, Netherlands

[4] Zuyderland Med Ctr, Heerlen, Netherlands

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

[6] Charite, Dept Rheumatol & Clin Immunol, Berlin, Germany

[7] Free Univ, Berlin, Germany

[8] Humboldt Univ, Berlin, Germany

[9] Karolinska Inst, Dept Rheumatol, Stockholm, Sweden

[10] Hop Cochin, Rhumatol B, Paris, France

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

[12] Univ Leeds, Leeds Inst Rheumat & Musculoskeletal Med, Leeds, W Yorkshire, England

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

[14] Univ Twente, Dept Psychol Hlth & Technol, Enschede, Netherlands

[15] Tech Univ Dresden, Univ Klinikum Carl Gustav Carus, Med Klin & Poliklin 2, Div Rheumatol, Dresden, Germany

[16] Vrije Univ Amsterdam, Med Ctr, Dept Epidemiol & Biostat, Amsterdam, Netherlands

[17] Univ Birmingham, Queen Elizabeth Hosp, IIA, Birmingham NIHR Wellcome Trust Clin Res Facil,Rhe, Birmingham, W Midlands, England

[18] Hosp Special Surg, Weill Cornell Med Coll, Dept Rheumatol, New York, NY USA

[19] Univ Toronto, Mt Sinai Hosp, Rebecca McDonald Ctr Arthrit & Autoimmune Dis, Toronto, ON, Canada

[20] Ctr Invest Clin Morelia SC, Michoacan, Mexico

[21] Univ Montpellier, UMR 5535, Lapeyronie Hosp, Rheumatol Dept, Montpellier, France

[22] Univ Genoa, Res Lab, Genoa, Italy

[23] Univ Genoa, Div Clin Rheumatol, Genoa, Italy

[24] Maastricht Univ, Dept Patient & Care, Maastricht, Netherlands

[25] Maastricht Univ, Dept Rheumatol, Maastricht, Netherlands

[26] Univ Hosp Geneva, Div Rheumatol, Geneva, Switzerland

[27] Hosp Clin Univ, Fdn Ramon Dominguez, Santiago, Spain

[28] Sorbonne Univ, Pitie Salpetriere Hosp, Dept Rheumatol, Paris, France

[29] Strasbourg Univ Hosp, Inst Biol Mol & Cellulaire Immunopathol & Chim Th, Strasbourg, France

[30] Univ Strasbourg, CNRS, Strasbourg, France

[31] Erasmus MC, Univ Med Ctr Rotterdam, Rotterdam, Netherlands

[32] Univ Manchester, Ctr Musculoskeletal Res, Arthritis Res UK Ctr Epidemiol, Manchester, Lancs, England

[33] VA Nasonova Res Inst Rheumatol, Moscow, Russia

[34] European League Rheumatism, Zurich, Switzerland

[35] Cyprus League Rheumatism, Nicosia, Cyprus

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

[37] Beijing Univ Peoples Hosp, Dept Rheumatol & Immunol, Beijing, Peoples R China

[38] Univ Paris Sud, Hop Univ Paris Sud, AP HP, INSERM U1184,Ctr Immunol Viral Infect & Autoimmun, Le Kremlin Bicetre, France

[39] Univ Glasgow, Coll Med Vet & Life Sci, Inst Infect Immun & Inflammat, Glasgow, Lanark, Scotland

[40] Org Med Invest, Buenos Aires, DF, Argentina

[41] Univ Queensland, Dept Med, Brisbane, Qld, Australia

[42] Charles Univ Prague, Inst Rheumatol & Clin Rheumatol, Prague, Czech Republic

[43] Semmelweis Univ, Natl Inst Rheumatol & Physiotherapy, Budapest, Hungary

[44] Pellegrin Hosp, FHU ACRONIM, Rheumatol Dept, Bordeaux, France

[45] Bordeaux Univ, UMR CNRS 5164, Bordeaux, France

[46] Dept Rheumatol, Bernhoven, Uden, Netherlands

[47] Univ Cologne, Cologne, Germany

[48] Univ Alabama Birmingham, Dept Med, Div Rheumatol, Birmingham, AL 35294 USA

[49] Ctr Hosp & Univ Coimbra Praceta Mota Pinto, Serv Reumatol, Coimbra, Portugal

[50] Med Univ Vienna, Ctr Med Stat Informat & Intelligent Syst, Sect Outcomes Res, Vienna, Austria

来源：

ANNALS OF THE RHEUMATIC DISEASES | 2017年 / 76卷 / 06期

关键词：

ADALIMUMAB PLUS METHOTREXATE; INTERLEUKIN-6 RECEPTOR INHIBITION; TREAT-TO-TARGET; STANDARDIZED OPERATING PROCEDURES; RAPID RADIOGRAPHIC PROGRESSION; CARDIOVASCULAR RISK-MANAGEMENT; DOSE GLUCOCORTICOID THERAPY; PLACEBO-CONTROLLED TRIAL; DMARD-NAIVE PATIENTS; DOUBLE-BLIND;

D O I：

10.1136/annrheumdis-2016-210715

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recommendations address conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GC); biological (b) DMARDs (tumour necrosis factor (TNF)-inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, clazakizumab, sarilumab and sirukumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (Janus kinase (Jak) inhibitors tofacitinib, baricitinib). Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. Cost aspects were taken into consideration. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at >50% improvement within 3 and target attainment within 6 months. If this fails stratification is recommended. Without unfavourable prognostic markers, switching to-or adding-another csDMARDs (plus short-term GC) is suggested. In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered. For each recommendation, levels of evidence and Task Force agreement are provided, both mostly very high. These recommendations intend informing rheumatologists, patients, national rheumatology societies, hospital officials, social security agencies and regulators about EULAR's most recent consensus on the management of RA, aimed at attaining best outcomes with current therapies.

引用

页码：960 / 977

页数：18

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