Turkish Compliance and Adaptation of EULAR 2013 Recommendations for the Management of Rheumatoid Arthritis with Synthetic and Biological Disease-Modifying Antirheumatic Drugs: Expert Opinion of TLAR

Abstract

Objectives: This study aims to report Turkish League Against Rheumatism's assessment on the compliance of European League Against Rheumatism 2013 treatment recommendations for rheumatoid arthritis with practices in Turkish rheumatology clinics and adaptations for Turkey. Materials and methods: Members of Turkish League Against Rheumatism and one rheumatoid arthritis patient voted for the 2013 recommendations of the European League Against Rheumatism for treatment of rheumatoid arthritis in two sessions. An item was changed and voted again only if at least 70% of participants wanted a change. Strength of recommendations was calculated for the items. Strength of recommendations for the changed items in the first and second voting rounds was compared by Wilcoxon signed-rank test. In case of significant difference, the item with higher strength of recommendation was accepted. In case of no difference, the changed item was selected. Results: Three overarching principles and fourteen recommendations were assessed among which the three overarching principles were changed emphasizing the importance of physiatrists as well as rheumatologists for taking care of the patients. Third item was changed by adding composite indices for assessing disease activity. In the ninth recommendation, rituximab was suggested as a first line drug independent of situations like latent tuberculosis or lymphoma, etc. In the 11 th recommendation, unlike European League Against Rheumatism, our committee did not suggest any thought about tofacitinib, as then it had not been approved in Turkey. Remaining principles were accepted as the same. Conclusion: Expert opinion of Turkish League Against Rheumatism for treatment of rheumatoid arthritis patients was formed for practices in Turkish clinics.

Turkish League Against Rheumatism (TLAR) Recommendations for the Pharmacological Management of Rheumatoid Arthritis: 2018 Update Under Guidance of Current Recommendations

“…Additionally, our expert committee emphasized the significance of a multidisciplinary approach including trained healthcare staff such as rheumatology nurses, physiotherapists, and occupational therapists as noted in EULAR 2013 and TLAR 2013 recommendations for RA management. 5,11 The LoA increased from 6.11±3.31 to 9.52±0.89 after the revision (p<0.001). The second version was accepted due to significantly increased agreement rate.…”

“…The term "with regard to composite indices" that was available in Turkish Compliance and Adaptation of EULAR 2013 recommendations for the management of RA was subtracted since it is presented in detail in explanations. 11 The use of composite disease activity indices is strongly recommended by the EULAR. These composite measures include tender and swollen joint counts as well as acute phase reactants, patient's health assessment, and the ACR/EULAR remission criteria.…”

“…Therefore, Turkish League Against Rheumatism (TLAR), a scientific member of the EULAR since 1947, developed recommendations for the management of RA in Turkey in 2011 and adapted the EULAR recommendations for the management of RA with synthetic and biological DMARDs into Turkish in 2013. 10,11 In this study, we aimed to report the assessment of the TLAR expert panel on the compliance and adaptation of the EULAR 2016 recommendations for the management of RA in Turkey. This is the third study to develop TLAR RA treatment recommendations based on EULAR recommendations to be used among Turkish rheumatologists and physical medicine and rehabilitation specialists taking care of RA patients.…”