A systematic review of guidelines for managing rheumatoid arthritis
Abstract Background We systematically reviewed current guidelines for managing rheumatoid arthritis (RA) to evaluate their range and nature, assess variations in their recommendations and highlight divergence in their perspectives. Methods We searched Medline and Embase databases using the terms ‘cl...
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| Format: | Article |
| Language: | English |
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BMC
2019-10-01
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| Series: | BMC Rheumatology |
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| Online Access: | http://link.springer.com/article/10.1186/s41927-019-0090-7 |
| _version_ | 1818400247975510016 |
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| author | Aneela Mian Fowzia Ibrahim David L. Scott |
| author_facet | Aneela Mian Fowzia Ibrahim David L. Scott |
| author_sort | Aneela Mian |
| collection | DOAJ |
| description | Abstract Background We systematically reviewed current guidelines for managing rheumatoid arthritis (RA) to evaluate their range and nature, assess variations in their recommendations and highlight divergence in their perspectives. Methods We searched Medline and Embase databases using the terms ‘clinical practice guidelines’ and ‘rheumatoid arthritis’ from January 2000 to January 2017 together with publications of national and international bodies. We included guidelines providing recommendations on general RA management spanning a range of treatments and published in English. We undertook narrative assessments due to the heterogeneity of the guidelines. Results We identified 529 articles; 22 met our inclusion criteria. They were primarily developed by rheumatologists with variable involvement of patient and other experts. Three dealt with early RA, one established RA and 18 all patients. Most guidelines recommend regular assessments based on the Outcome Measures in Rheumatology core dataset; 18 recommended the disease activity score for 28 joints. Twenty recommended targeting remission; 16 suggested low disease activity as alternative. All guidelines recommend treating active RA; 13 made recommendations for moderate disease. The 21 guidelines considering early RA all recommended starting disease modifying drugs (DMARDs) as soon as possible; methotrexate was recommended for most patients. Nineteen recommended combination DMARDs when patients failed to respond fully to monotherapy and biologics were not necessarily indicated. Twenty made recommendations about biologics invariably suggesting their use after failing conventional DMARDs, particularly methotrexate. Most did not make specific recommendations about using one class of biologics preferentially. Eight recommended tapering biologics when patients achieved sustained good responses. Conclusions Five general principles transcend most guidelines: DMARDs should be started as soon as possible after the diagnosis; methotrexate is the best initial treatment; disease activity should be regularly monitored; give biologics to patients with persistently active disease who have already received methotrexate; remission or low disease activity are the preferred treatment target. |
| first_indexed | 2024-12-14T07:33:33Z |
| format | Article |
| id | doaj.art-af1b56cdf1d74fb0aa8408e4a6e3cab7 |
| institution | Directory Open Access Journal |
| issn | 2520-1026 |
| language | English |
| last_indexed | 2024-12-14T07:33:33Z |
| publishDate | 2019-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Rheumatology |
| spelling | doaj.art-af1b56cdf1d74fb0aa8408e4a6e3cab72022-12-21T23:11:16ZengBMCBMC Rheumatology2520-10262019-10-013111310.1186/s41927-019-0090-7A systematic review of guidelines for managing rheumatoid arthritisAneela Mian0Fowzia Ibrahim1David L. Scott2Academic Rheumatology, Department of Inflammation Biology, School of Immunology And Microbial Sciences, King’s College London, Weston Education CentreAcademic Rheumatology, Department of Inflammation Biology, School of Immunology And Microbial Sciences, King’s College London, Weston Education CentreAcademic Rheumatology, Department of Inflammation Biology, School of Immunology And Microbial Sciences, King’s College London, Weston Education CentreAbstract Background We systematically reviewed current guidelines for managing rheumatoid arthritis (RA) to evaluate their range and nature, assess variations in their recommendations and highlight divergence in their perspectives. Methods We searched Medline and Embase databases using the terms ‘clinical practice guidelines’ and ‘rheumatoid arthritis’ from January 2000 to January 2017 together with publications of national and international bodies. We included guidelines providing recommendations on general RA management spanning a range of treatments and published in English. We undertook narrative assessments due to the heterogeneity of the guidelines. Results We identified 529 articles; 22 met our inclusion criteria. They were primarily developed by rheumatologists with variable involvement of patient and other experts. Three dealt with early RA, one established RA and 18 all patients. Most guidelines recommend regular assessments based on the Outcome Measures in Rheumatology core dataset; 18 recommended the disease activity score for 28 joints. Twenty recommended targeting remission; 16 suggested low disease activity as alternative. All guidelines recommend treating active RA; 13 made recommendations for moderate disease. The 21 guidelines considering early RA all recommended starting disease modifying drugs (DMARDs) as soon as possible; methotrexate was recommended for most patients. Nineteen recommended combination DMARDs when patients failed to respond fully to monotherapy and biologics were not necessarily indicated. Twenty made recommendations about biologics invariably suggesting their use after failing conventional DMARDs, particularly methotrexate. Most did not make specific recommendations about using one class of biologics preferentially. Eight recommended tapering biologics when patients achieved sustained good responses. Conclusions Five general principles transcend most guidelines: DMARDs should be started as soon as possible after the diagnosis; methotrexate is the best initial treatment; disease activity should be regularly monitored; give biologics to patients with persistently active disease who have already received methotrexate; remission or low disease activity are the preferred treatment target.http://link.springer.com/article/10.1186/s41927-019-0090-7Rheumatoid arthritisSystematic reviewManagement guidelines |
| spellingShingle | Aneela Mian Fowzia Ibrahim David L. Scott A systematic review of guidelines for managing rheumatoid arthritis BMC Rheumatology Rheumatoid arthritis Systematic review Management guidelines |
| title | A systematic review of guidelines for managing rheumatoid arthritis |
| title_full | A systematic review of guidelines for managing rheumatoid arthritis |
| title_fullStr | A systematic review of guidelines for managing rheumatoid arthritis |
| title_full_unstemmed | A systematic review of guidelines for managing rheumatoid arthritis |
| title_short | A systematic review of guidelines for managing rheumatoid arthritis |
| title_sort | systematic review of guidelines for managing rheumatoid arthritis |
| topic | Rheumatoid arthritis Systematic review Management guidelines |
| url | http://link.springer.com/article/10.1186/s41927-019-0090-7 |
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