Arthritis and Rheumatology, volume 73, issue 7, pages 1108-1123
2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis
Liana Fraenkel
1
,
Joan M. Bathon
2
,
Bryant England
3
,
E. William St. Clair
4
,
Thurayya Arayssi
5
,
Kristine Carandang
6
,
Kevin D. Deane
7
,
M. Genovese
8
,
Kent Kwas Huston
9
,
Gail Kerr
10
,
Joel M. Kremer
11
,
Mary C. Nakamura
12
,
Linda A. Russell
13
,
J. P. Singh
14
,
Benjamin J. Smith
15
,
Jeffrey A. Sparks
16
,
Shilpa Venkatachalam
17
,
MICHAEL E. WEINBLATT
16
,
Mounir Al Gibbawi
18
,
Joshua F Baker
19
,
Kamil E. Barbour
20
,
Jennifer L Barton
21
,
Laura C. Cappelli
22
,
Fatimah Chamseddine
18
,
Michael D. George
23
,
Sindhu R. Johnson
24
,
Lara Kahale
18
,
Basil S. Karam
18
,
Assem M. Khamis
18
,
Iris Navarro-Millan
25
,
Reza Mirza
26
,
Pascale Schwab
21
,
Namrata Singh
27
,
Marat Turgunbaev
28
,
Amy V. Turner
28
,
Sally Yaacoub
18
,
Elie A Akl
18
5
Weill Cornell Medicine–Qatar Doha Qatar
|
9
The Center for Rheumatic Disease/Allergy and Immunology Kansas City Missouri United States
|
11
Albany Medical College and The Center for Rheumatology Albany New York United States
|
13
Hospital for Special Surgery New York New York United States
|
15
17
Global Healthy Living Foundation Upper Nyack New York United States
|
20
Centers for Disease Control and Prevention Atlanta Georgia United States
|
21
Oregon Health & Science University and VA Portland Health Care System Portland Oregon United States
|
28
American College of Rheumatology Atlanta Georgia United States
|
Publication type: Journal Article
Publication date: 2021-06-08
Journal:
Arthritis and Rheumatology
scimago Q1
SJR: 3.708
CiteScore: 20.9
Impact factor: 11.4
ISSN: 23265191, 23265205
Immunology
Immunology and Allergy
Rheumatology
Abstract
To develop updated guidelines for the pharmacologic management of rheumatoid arthritis.We developed clinically relevant population, intervention, comparator, and outcomes (PICO) questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A voting panel comprising clinicians and patients achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.The guideline addresses treatment with disease-modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs, use of glucocorticoids, and use of DMARDs in certain high-risk populations (i.e., those with liver disease, heart failure, lymphoproliferative disorders, previous serious infections, and nontuberculous mycobacterial lung disease). The guideline includes 44 recommendations (7 strong and 37 conditional).This clinical practice guideline is intended to serve as a tool to support clinician and patient decision-making. Recommendations are not prescriptive, and individual treatment decisions should be made through a shared decision-making process based on patients' values, goals, preferences, and comorbidities.
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