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

被引：1467

作者：

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

Landewe, Robert ^{[3
]}

Breedveld, Ferdinand C. ^{[4
]}

Dougados, Maxime ^{[5
]}

Emery, Paul ^{[6
]}

Gaujoux-Viala, Cecile ^{[5
,7
]}

Gorter, Simone ^{[3
]}

Knevel, Rachel ^{[4
]}

Nam, Jackie ^{[6
]}

Schoels, Monika ^{[2
]}

Aletaha, Daniel ^{[1
]}

Buch, Maya ^{[6
]}

Gossec, Laure ^{[5
]}

Huizinga, Tom ^{[4
]}

Bijlsma, Johannes W. J. W. ^{[8
]}

Burmester, Gerd ^{[9
]}

Combe, Bernard ^{[10
]}

Cutolo, Maurizio ^{[11
]}

Gabay, Cem ^{[12
]}

Gomez-Reino, Juan ^{[13
]}

Kouloumas, Marios ^{[14
]}

Kvien, Tore K. ^{[15
]}

Martin-Mola, Emilio ^{[16
]}

McInnes, Iain ^{[17
]}

Pavelka, Karel ^{[18
,19
]}

van Riel, Piet ^{[20
]}

Scholte, Marieke ^{[14
]}

Scott, David L. ^{[21
]}

Sokka, Tuulikki ^{[22
]}

Valesini, Guido ^{[23
]}

van Vollenhoven, Ronald ^{[24
]}

Winthrop, Kevin L. ^{[25
]}

Wong, John ^{[26
]}

Zink, Angela ^{[27
,28
]}

van der Heijde, Desiree ^{[4
]}

机构：

[1] Med Univ Vienna, Div Rheumatol, Dept Med 3, A-1090 Vienna, Austria

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

[3] Univ Hosp Maastricht, Dept Internal Med Rheumatol, Maastricht, Netherlands

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

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

[6] Univ Leeds, Leeds Inst Mol Med, Sect Musculoskeletal Dis, Leeds, W Yorkshire, England

[7] Univ Paris 06, Pitie Salpetriere Hosp, AP HP, Paris, France

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

[9] Humboldt Univ, Charite Hosp, Dept Rheumatol & Clin Immunol, Berlin, Germany

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

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

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

[13] Univ Santiago, Sch Med, Clin Hosp, Santiago De Compostela, Spain

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

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

[16] Hosp La Paz, Madrid, Spain

[17] Univ Glasgow, Glasgow, Lanark, Scotland

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

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

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

[21] Kings Coll London, Sch Med, Weston Educ Ctr, London WC2R 2LS, England

[22] Jyvaskyla Cent Hosp, Dept Rheumatol, Jyvaskyla, Finland

[23] Univ Roma La Sapienza, Rheumatol Unit, Dept Clin Med & Med Therapy, Rome, Italy

[24] Karolinska Univ Hosp, Karolinska Inst, Dept Med, Rheumatol Unit, Solna, Sweden

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

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

[27] Charite, D-13353 Berlin, Germany

[28] German Rheumatism Res Ctr, Berlin, Germany

来源：

ANNALS OF THE RHEUMATIC DISEASES | 2010年 / 69卷 / 06期

关键词：

LOW-DOSE PREDNISOLONE; DOUBLE-BLIND; COMBINATION THERAPY; METHOTREXATE MONOTHERAPY; CLINICAL-TRIAL; RADIOGRAPHIC PROGRESSION; FUNCTIONAL DISABILITY; TREATMENT STRATEGIES; MONOCLONAL-ANTIBODY; RECEPTOR ANTAGONIST;

D O I：

10.1136/ard.2009.126532

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Treatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-a-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion.

引用

页码：964 / 975

页数：12

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