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2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis
Author(s) -
Fraenkel Liana,
Bathon Joan M.,
England Bryant R.,
St.Clair E. William,
Arayssi Thurayya,
Carandang Kristine,
Deane Kevin D.,
Genovese Mark,
Huston Kent Kwas,
Kerr Gail,
Kremer Joel,
Nakamura Mary C.,
Russell Linda A.,
Singh Jasvinder A.,
Smith Benjamin J.,
Sparks Jeffrey A.,
Venkatachalam Shilpa,
Weinblatt Michael E.,
AlGibbawi Mounir,
Baker Joshua F.,
Barbour Kamil E.,
Barton Jennifer L.,
Cappelli Laura,
Chamseddine Fatimah,
George Michael,
Johnson Sindhu R.,
Kahale Lara,
Karam Basil S.,
Khamis Assem M.,
Navarro-Millán Iris,
Mirza Reza,
Schwab Pascale,
Singh Namrata,
Turgunbaev Marat,
Turner Amy S.,
Yaacoub Sally,
Akl Elie A.
Publication year - 2021
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.41752
Subject(s) - medicine , guideline , rheumatoid arthritis , intensive care medicine , physical therapy , rheumatology , rituximab , grading (engineering) , population , pathology , lymphoma , environmental health , civil engineering , engineering
Objective To develop updated guidelines for the pharmacologic management of rheumatoid arthritis. Methods 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. Results 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). Conclusion 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.