Navigation Links
EULAR issues updated rheumatoid arthritis management recommendations
Date:7/3/2013

The European League Against Rheumatism (EULAR) has released updated recommendations for the management of RA. According to this latest guidance, treatment with disease-modifying anti-rheumatic drugs (DMARDs) should be initiated as soon as a diagnosis of RA is made, with the aim of reaching a target of remission or low disease activity in every patient.

As first-line treatment, EULAR recommends rheumatologists administer methotrexate (MTX) or combination therapy of MTX with other conventional synthetic DMARDs. Low-dose glucocorticoids should also be considered in combination with DMARDs for up to six months, but should be tapered as soon as clinically feasible.

"These recommendations were based on three extensive literature reviews of the efficacy and safety of biological and conventional DMARDs, and address a number of common misinterpretations of the 2010 guidelines," according to Professor Josef Smolen, Medical University of Vienna and Hietzing Hospital, Vienna. "As already stated in 2010, by advocating the use of synthetic DMARDs, rather than biologics, as the first-line treatment this approach avoids the over-treatment of 20-50% of patients with early RA, who will achieve the treatment target with such initial therapy" he concluded for the Task Force.

However, in patients failing to respond to this treatment within 6 months and when poor prognostic factors are present, biological DMARDs (TNF-inhibitors, abatacept or tocilizumab or under certain circumstances rituximab) should be administered in combination with MTX.

The document further recommends that patients who have failed to respond to an initial biologic DMARD should receive another biologic DMARD. Patients who have failed to respond to an initial TNF-inhibitor may receive another TNF-inhibitor, or a biologic with an alternative mode of action. If biologic treatment has failed, tofacitinib may be considered where approved.

"Although the European Medicines Agency has not approved tofacitinib hitherto, it has been approved by the US Food and Drug Administration as well as in Japan and Russia. Having weighed up the evidence, the Task Force is convinced of its efficacy on clinical outcomes, function and structure. However, until more safety data are available and efficacy judged in clinical practice, tofacitinib is only recommended after at least one biological has failed in fact, many Task Force members felt it should be used after two biological treatment failures," concluded Professor Smolen.

If a patient has achieved persistent remission, and after having tapered glucocorticoids, clinicians should consider tapering the biological DMARD, particularly if the treatment is in combination with a conventional synthetic DMARD. In cases of sustained long-term remission, cautious dose-reduction of conventional synthetic DMARDs should be considered.

In addition to the latest treatment recommendations, the guidelines also contain a number of over-arching principles addressing patient care. The guidelines recommend that the primary healthcare provider to RA patients should be a rheumatologist. In addition, monitoring of disease activity should take place every one to three months dependent on the disease activity, with alterations to therapy considered if no improvement is observed by three months post-treatment, or if the target has not been reached by six months. Any initiation and adjustments of therapy should be made as a shared decision between patient and clinician, with factors including disease activity, progression of structural damage, co-morbidities and safety issues taken into account.


'/>"/>

Contact: EULAR Press Office
eularpressoffice@cohnwolfe.com
44-020-733-15364
European League Against Rheumatism
Source:Eurekalert

Related medicine news :

1. UCSF chancellor issues call-to-arms to patient advocates
2. Radiologists rank themselves as less than competent on health policy issues
3. Genetic abnormalities in benign or malignant tissues predict relapse of prostate cancer
4. FDA Issues Multiple Sclerosis Drug Alert
5. Quality of care, other issues may cause worse results in black prostate cancer surgery patients
6. U.S. Task Force Issues Blood Pressure Guidelines
7. Internists in Washington to discuss patient and professional issues in meetings on Capitol Hill
8. Cheaper drug could lead to serious eye issues
9. Insulite Labs announces the launch of the PCOS Inspiration Hour, a one hour virtual gathering place for women with PCOS and other women’s health issues to come together.
10. LawyersandSettlements.com Issues Report on Prostate Health Claim Lawsuits and Propecia Side Effect Litigation
11. What Men Should Know About Veins: Varicose Veins and Venous Disease are Real Medical Issues
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/26/2016)... ... June 26, 2016 , ... PawPaws brand pet supplements ... was developed to enhance the health of felines. The formula is all-natural and is ... herbs in the PawPaws Cat Kidney Support Supplement Soft Chews are Astragalus ...
(Date:6/25/2016)... (PRWEB) , ... June 25, 2016 , ... The temporary closing of Bruton Memorial Library ... City Observer , brings up a new, often overlooked aspect of head lice: the parasite’s ... for fumigation is not a common occurrence, but a necessary one in the event that ...
(Date:6/25/2016)... ... June 25, 2016 , ... On Friday, June 10, Van ... Wellness at Work award to iHire in recognition of their exemplary accomplishments in worksite ... 7th annual Maryland Workplace Health & Wellness Symposium at the BWI Marriott in Linthicum ...
(Date:6/24/2016)... ... ... crisis. Her son James, eight, was out of control. Prone to extreme mood shifts and ... him, he couldn’t control his emotions,” remembers Marcy. “If there was a knife on ... say he was going to kill them. If we were driving on the freeway, ...
(Date:6/24/2016)... ... ... of Topricin and MyPainAway Pain Relief Products, join The ‘Business for a Fair Minimum Wage’ ... 2020 and then adjusting it yearly to increase at the same rate as the median ... floor does not erode again, and make future increases more predictable. , The company is ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... -- Any dentist who has made an implant supported denture ... of them do not even offer this as a viable ... costs involved. And those who ARE able to offer that ... cost that the majority of today,s patients would not be ... , founder of Dental Evolutions Inc. and inventor of Implanova ...
(Date:6/23/2016)...  In a startling report released today, National Safety Council ... a comprehensive, proven plan to eliminate prescription opioid overdoses. ... states are tackling the worst drug crisis in recorded U.S. history, ... Kentucky , New Mexico , ... the 28 failing states, three – Michigan , ...
(Date:6/23/2016)... 23, 2016 Research and Markets has ... Market Analysis 2016 - Forecast to 2022" report to ... report contains up to date financial data derived from varied ... major trends with potential impact on the market during the ... segmentation which comprises of sub markets, regional and country level ...
Breaking Medicine Technology: