Navigation Links
American College of Rheumatology presents recommendations for rheumatoid arthritis therapy
Date:6/3/2008

To manage the painful and incapacitating symptoms of rheumatoid arthritis (RA), a chronic, inflammatory joint disease, the majority of patients rely on disease-modifying antirheumatic drugs (DMARDs). In addition to trusted nonbiologic DMARDs, a number of biologic agents now promise to improve treatment for RA. The American College of Rheumatology (ACR), respected worldwide for its devotion to fostering excellence in patient care, has not updated recommendations for non-biologic DMARDs since 2002 and has not previously developed recommendations for biologic agents. In view of that, ACR decided it was time for a major re-evaluation of the use of DMARD therapy in rheumatoid arthritis.

Under the guidance of a Core Expert Panel of clinicians and methodologists and based on a systematic review of the scientific evidence, a second group of internationally recognized clinicians, methodologists, and patient representatives with extensive expertise in the use of nonbiologic and biologic DMARDs developed these recommendations for the ACR and the results of their work will be presented in the June 2008 issue of Arthritis Care & Research (www.interscience.wiley.com/journal/arthritis). These recommendations on the use of non-biologic and biologic DMARDs in RA address 5 key areas pre-specified by the ACR: indications for use, monitoring for side-effects, assessing the clinical response, screening for tuberculosis (a risk factor associated with biologic DMARDs), and under certain circumstances (i.e. high disease activity) the roles of cost and patient preference in choosing biologic agents. When developing these recommendations, RA disease duration, disease severity, and prognostic features were also considered.

"These recommendations were developed for specialist clinicians familiar with assessing RA disease activity and disease severity," notes Kenneth Saag, M.D., Professor of Medicine and Epidemiology at The University of Alabama at Birmingham, who co-led the project . "Applying these recommendations to clinical practice requires individualized patient assessment and clinical decision-making. The recommendations developed are not intended to be used in a 'cookbook' or prescriptive manner or to limit a physicians clinical judgment, but rather to provide guidance based on clinical evidence and expert panel input."

The ACR 2008 recommendations for nonbiologic and biologic DMARD use in RA include:

  • Initiating methotrexate or leflunomide therapy was recommended for most RA patients.

  • Methotrexate plus hydroxychloroquine was endorsed for patients with moderate to high disease activity.

  • The triple DMARD combination of methotrexate plus hydroxychloroquine plus sulfasalazine for patients with poor prognostic features and moderate to high levels of disease activity.

  • Prescribing anti-TNF agents -- etanercept, infliximab, or adalimumab -- along with methotrexate in early RA (less than 3 months) only for patients with high disease activity who had never received DMARDs. In intermediate- and longer-duration RA, anti-TNF agents were recommended for patients who had failed to respond adequately to methotrexate therapy.

  • Reserving the fusion protein abatacept and the B-cell antibody(rituximab) for patients with at least moderate disease activity and poor disease prognosis for whom methotrexate in combination with or sequential administration of other nonbiologic DMARDs led to an inadequate response.

  • Avoiding the initiation or resumption of treatment with methotrexate, leflunomide, or biologic agents for patients with active bacterial infection, active herpes-zoster viral infection, active or latent tuberculosis, or acute or chronic hepatitis B or C.

  • Not prescribing anti-TNF agents to patients with a history of heart failure, with a history of lymphoma, or with multiple sclerosis or demyelinating disorders.

  • Avoiding the initiation or resumption of methotrexate, leflunomide, or minocycline for RA patients planning for pregnancy and throughout the duration of pregnancy and breastfeeding.

"These recommendations are extensive but not comprehensive," Dr. Saag acknowledges, "and it is intended that they will be regularly updated to reflect the rapidly growing scientific evidence in this area along with changing practice patterns in rheumatology."


'/>"/>

Contact: Sean Wagner
swagner@wiley.com
781-388-8550
Wiley-Blackwell
Source:Eurekalert

Related medicine news :

1. American Italian Pasta Company Extends Line of Healthier Pastas With Heartland(R) Perfect Balance
2. American Diabetes Association Receives $450,000 Grant From Abbott Fund for Latino Community Initiatives
3. American Academy of Pediatrics Launches 2008 National Art Contest for Children
4. Animal Dermatology Clinic - San Diego Announces Dr. Brett Wildermuth, DVM, Achieves Diplomate Status With the American College of Veterinary Dermatology
5. Isis Partners Present Clinical Data on Antisense Drugs at the American Society of Clinical Oncology
6. American Oriental Bioengineering Announces US$75 Million Share Repurchase Program
7. Indiana University research at the American College of Sports Medicine annual conference
8. Jeff Bailet, M.D., Appointed to American Medical Associations Advisory Committee
9. American Lung Association of Iowa: Summer Camp Helps Kids With Asthma
10. Delisting Notification Received from the American Stock Exchange
11. American Cancer Society, Patient Advocate Foundation Announce Free, Personalized Assistance for Cancer Patients
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/13/2017)... ... , ... The American Board of Family Medicine's (ABFM) Board of Directors has ... succeeding Dr. James C. Puffer upon his retirement. Dr. Newton will serve in the ... at the end of 2018. Upon assuming the role of President and CEO on ...
(Date:10/13/2017)... , ... October 13, 2017 ... ... of Pharmacy (SOP) alumni Hannah Randall, PharmD ‘17, and Jennifer Huggins, PharmD ... on guideline updates for the primary prevention of cardiovascular diseases during the ...
(Date:10/13/2017)... Calif. (PRWEB) , ... October 13, 2017 , ... Many ... dementia. However, many long-term care insurance companies have a waiver for care if the ... 90-day elimination period, when the family pays for care, is often waived, so the ...
(Date:10/13/2017)... ... October 13, 2017 , ... Global Healthcare Management’s 4th ... Park in Milford, NJ. This free event, sponsored by Global Healthcare Management’s CEO, ... The fun run is geared towards children of all ages; it is a non-competitive, ...
(Date:10/13/2017)... ... October 13, 2017 , ... Coveros, a leader ... been awarded a contract by the Center for Medicare and Medicaid Services (CMS). ... the enterprise use of Agile methodologies in a consistent and high value manner ...
Breaking Medicine News(10 mins):
(Date:10/4/2017)... 2017  According to the Centers for Disease Control and Prevention (CDC), ... PhysicianOne Urgent Care is helping communities across Massachusetts , ... by offering no-cost* flu shots through the end of the month. ... insurance regulations. ... get a flu shot is by the end of October, according to ...
(Date:10/2/2017)... 2017  Eli Lilly and Company (NYSE: ... third quarter of 2017 on Tuesday, October 24, 2017. ... day with the investment community and media to further ... call will begin at 9 a.m. Eastern time. Investors, ... webcast of the conference call through a link that ...
(Date:10/2/2017)... , Oct. 2, 2017 The Rebound mobile ... the struggle to reverse the tide of prescription drug addiction. ... regulating their medicine intake and stepping down their dosage in ... to launch in December 2017; the first 100,000 people to ... more at http://www.rebound-solution.com/ ...
Breaking Medicine Technology: