Open Access
EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update
J. Smolen
1, 2
,
Robert Landew??
3, 4
,
Sytske Anne Bergstra
5, 6
,
Andreas Kerschbaumer
1, 2
,
Alexandre Rocha Sepriano
7
,
Daniel Aletaha
1, 2
,
Roberto Caporali
8, 9
,
Christopher John Edwards
10, 11
,
Kimme Hyrich
12, 13
,
Janet E. Pope
14, 15
,
Savia De Souza
16
,
Tanja A Stamm
2, 17
,
Tsutomu Takeuchi
18, 19
,
Patrick Verschueren
5, 20
,
Kevin Winthrop
21
,
Alejandro C. Balsa
22, 23
,
Joan M. Bathon
24
,
Maya H Buch
25
,
Gerd-Rüdiger Burmester
26, 27
,
Frank Buttgereit
26, 27
,
Mario Humberto Cardiel
28
,
K Chatzidionysiou
29, 30
,
Catalin Codreanu
31, 32
,
Maurizio Cutolo
33, 34
,
Alfons A den Broeder
35
,
Khadija El Aoufy
36, 37
,
A Finckh
38, 39
,
João Eurico Fonseca
40, 41
,
Espen A Haavardsholm
43, 44
,
Annamaria Iagnocco
45, 46
,
Kim Lauper
38, 39
,
Zhanguo Li
47, 48
,
Iain B. McInnes
49, 50
,
Eduardo F Mysler
51
,
P. Nash
52, 53
,
Gyula Poor
54, 55
,
Gorica G Ristic
56, 57
,
Felice Rivellese
58, 59
,
Andrea Rubbert-Roth
60, 61
,
Hendrik Schulze-Koops
62, 63
,
Nikolay Stoilov
64, 65
,
Anja Strangfeld
29, 30, 66, 67
,
Annette Van Der Helm Van Mil
5, 6
,
Elsa Van Duuren
68
,
Theodora PM Vliet Vlieland
6, 69
,
R Westhovens
5, 20
,
Désirée van der Heijde
5, 6
1
Division of Rheumatology, Department of Medicine 3
3
Division of Clinical Immunology and Rheumatology
5
Department of Rheumatology
7
CHRC Campus Nova Medical School
8
Milan & Department of Rheumatology, ASST PINI-CTO
|
12
15
Schulich School of Medicine & Dentistry
16
EULAR Patient Research Partner Network
17
Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems
24
26
Department of Rheumatology and Clinical Immunology
28
Centro de Investigación Clínica de Morelia
|
31
Center for Rheumatic Diseases
32
University of Medicine and Pharmacy
33
Laboratory of Experimental Rheumatology and Division of Rheumatology DiMI, Department of Internal Medicine and Medical Specialties
34
35
36
Department of Experimental and Clinical Medicine
38
Division of Rheumatology, Department of Medicine
43
Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY)
45
Academic Rheumatology Centre - AO Mauriziano Torino, Cattedra di Reumatologia - Dipartimento Scienze Cliniche e Biologiche
47
Department of Rheumatology and Immunology
49
College of Medical Veterinary and Life Sciences
51
Organizacion Medica de Investigación
52
School of Medicine
54
National Institute of Musculoskeletal Disorders
56
Department of Rheumatology and Clinical Immunology and Medical Faculty of the Military Medical Academy
57
The University of Defense in Belgrade
58
Centre for Experimental Medicine and Rheumatology
59
William Harvey Research Institute
|
60
Division of Rheumatology and Clinical Immunology
62
Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV
64
Department of Rheumatology, Faculty of Medicine, University Hospital “St. Ivan Rilski”
66
Programme Area of Epidemiology and Health Services Research
69
Department of Orthopaedics, Rehabilitation and Physical Therapy
Publication type: Journal Article
Publication date: 2022-11-10
scimago Q1
wos Q1
SJR: 5.731
CiteScore: 33.2
Impact factor: 20.6
ISSN: 00034967, 14682060
PubMed ID:
36357155
General Biochemistry, Genetics and Molecular Biology
Immunology
Immunology and Allergy
Rheumatology
Abstract
Objectives
To provide an update of the EULAR rheumatoid arthritis (RA) management recommendations addressing the most recent developments in the field.
Methods
An international task force was formed and solicited three systematic literature research activities on safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs). The new evidence was discussed in light of the last update from 2019. A predefined voting process was applied to each overarching principle and recommendation. Levels of evidence and strengths of recommendation were assigned to and participants finally voted on the level of agreement with each item.
Results
The task force agreed on 5 overarching principles and 11 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); GCs; biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab including biosimilars), abatacept, rituximab, tocilizumab, sarilumab and targeted synthetic (ts) DMARDs, namely the Janus kinase inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib. Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering in sustained clinical remission is provided. Safety aspects, including risk of major cardiovascular events (MACEs) and malignancies, costs and sequencing of b/tsDMARDs were all considered. Initially, MTX plus GCs is recommended and on insufficient response to this therapy within 3–6 months, treatment should be based on stratification according to risk factors; With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD should be added to the csDMARD; after careful consideration of risks of MACEs, malignancies and/or thromboembolic events tsDMARDs may also be considered in this phase. If the first bDMARD (or tsDMARD) fails, any other bDMARD (from another or the same class) or tsDMARD (considering risks) is recommended. With sustained remission, DMARDs may be tapered but should not be stopped. Levels of evidence and levels of agreement were high for most recommendations.
Conclusions
These updated EULAR recommendations provide consensus on RA management including safety, effectiveness and cost.
Found
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Found
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Smolen J. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update // Annals of the Rheumatic Diseases. 2022. Vol. 82. No. 1. p. ard-2022-223356.
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Smolen J. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update // Annals of the Rheumatic Diseases. 2022. Vol. 82. No. 1. p. ard-2022-223356.
Cite this
RIS
Copy
TY - JOUR
DO - 10.1136/ard-2022-223356
UR - https://doi.org/10.1136/ard-2022-223356
TI - EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update
T2 - Annals of the Rheumatic Diseases
AU - Smolen, J.
AU - Landew??, Robert
AU - Bergstra, Sytske Anne
AU - Kerschbaumer, Andreas
AU - Sepriano, Alexandre Rocha
AU - Aletaha, Daniel
AU - Caporali, Roberto
AU - Edwards, Christopher John
AU - Hyrich, Kimme
AU - Pope, Janet E.
AU - De Souza, Savia
AU - Stamm, Tanja A
AU - Takeuchi, Tsutomu
AU - Verschueren, Patrick
AU - Winthrop, Kevin
AU - Balsa, Alejandro C.
AU - Bathon, Joan M.
AU - Buch, Maya H
AU - Burmester, Gerd-Rüdiger
AU - Buttgereit, Frank
AU - Cardiel, Mario Humberto
AU - Chatzidionysiou, K
AU - Codreanu, Catalin
AU - Cutolo, Maurizio
AU - den Broeder, Alfons A
AU - El Aoufy, Khadija
AU - Finckh, A
AU - Fonseca, João Eurico
AU - Gottenberg, Jacques-Eric
AU - Haavardsholm, Espen A
AU - Iagnocco, Annamaria
AU - Lauper, Kim
AU - Li, Zhanguo
AU - McInnes, Iain B.
AU - Mysler, Eduardo F
AU - Nash, P.
AU - Poor, Gyula
AU - Ristic, Gorica G
AU - Rivellese, Felice
AU - Rubbert-Roth, Andrea
AU - Schulze-Koops, Hendrik
AU - Stoilov, Nikolay
AU - Strangfeld, Anja
AU - Van Der Helm Van Mil, Annette
AU - Van Duuren, Elsa
AU - Vliet Vlieland, Theodora PM
AU - Westhovens, R
AU - Heijde, Désirée van der
PY - 2022
DA - 2022/11/10
PB - Elsevier
SP - ard-2022-223356
IS - 1
VL - 82
PMID - 36357155
SN - 0003-4967
SN - 1468-2060
ER -
Cite this
BibTex (up to 50 authors)
Copy
@article{2022_Smolen,
author = {J. Smolen and Robert Landew?? and Sytske Anne Bergstra and Andreas Kerschbaumer and Alexandre Rocha Sepriano and Daniel Aletaha and Roberto Caporali and Christopher John Edwards and Kimme Hyrich and Janet E. Pope and Savia De Souza and Tanja A Stamm and Tsutomu Takeuchi and Patrick Verschueren and Kevin Winthrop and Alejandro C. Balsa and Joan M. Bathon and Maya H Buch and Gerd-Rüdiger Burmester and Frank Buttgereit and Mario Humberto Cardiel and K Chatzidionysiou and Catalin Codreanu and Maurizio Cutolo and Alfons A den Broeder and Khadija El Aoufy and A Finckh and João Eurico Fonseca and Jacques-Eric Gottenberg and Espen A Haavardsholm and Annamaria Iagnocco and Kim Lauper and Zhanguo Li and Iain B. McInnes and Eduardo F Mysler and P. Nash and Gyula Poor and Gorica G Ristic and Felice Rivellese and Andrea Rubbert-Roth and Hendrik Schulze-Koops and Nikolay Stoilov and Anja Strangfeld and Annette Van Der Helm Van Mil and Elsa Van Duuren and Theodora PM Vliet Vlieland and R Westhovens and Désirée van der Heijde and others},
title = {EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update},
journal = {Annals of the Rheumatic Diseases},
year = {2022},
volume = {82},
publisher = {Elsevier},
month = {nov},
url = {https://doi.org/10.1136/ard-2022-223356},
number = {1},
pages = {ard--2022--223356},
doi = {10.1136/ard-2022-223356}
}
Cite this
MLA
Copy
Smolen, J., et al. “EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update.” Annals of the Rheumatic Diseases, vol. 82, no. 1, Nov. 2022, pp. ard-2022-223356. https://doi.org/10.1136/ard-2022-223356.