What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines

Abstract

Systematic r eview to evaluate the quality of the clinical practice guidelines (CPG) for rheumatoid arthritis (RA) management and to provide a synthesis of high-quality CPG recommendations, highlighting areas of consistency, and inconsistency. Electronic searches of five databases and four online guideline repositories were performed. RA management CPGs were eligible for inclusion if they were written in English and published between January 2015 and February 2022; focused on adults ≥ 18 years of age; met the criteria of a CPG as defined by the Institute of Medicine; and were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II instrument. RA CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organization of care and did not include interventional management recommendations; and/or included other arthritic conditions. Of 27 CPGs identified, 13 CPGs met eligibility criteria and were included. Non-pharmacological care should include patient education, patient-centered care, shared decision-making, exercise, orthoses, and a multi-disciplinary approach to care. Pharmacological care should include conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), with methotrexate as the first-line choice. If monotherapy conventional synthetic DMARDs fail to achieve a treatment target, this should be followed by combination therapy conventional synthetic DMARDs (leflunomide, sulfasalazine, hydroxychloroquine), biologic DMARDS and targeted synthetic DMARDS. Management should also include monitoring, pre-treatment investigations and vaccinations, and screening for tuberculosis and hepatitis. Surgical care should be recommended if non-surgical care fails. This synthesis offers clear guidance of evidence-based RA care to healthcare providers. Trial registration The protocol for this review was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/UB3Y7).

The temporal association between adverse drug reactions and antirheumatic drugs utilisation in Western Australia: a retrospective study from real-world data (1995–2015)

“…The characteristics of patients, multiple medication uses, and drug responses can all modify how DMARDs respond adversely [ 33 , 34 ]. To avoid these risks, practitioners must monitor their patients and adjust their treatment [ 35 ].…”

“…This highlights the importance of healthcare professionals being aware of and actively managing the ADRs of DMARDs. This includes comprehensive assessment [ 36 ], safe prescribing [ 37 ], risk communications [ 36 ], monitoring [ 35 ], education [ 36 ], post-marketing surveillance [ 38 ], and reporting ADRs to the relevant authorities.…”

Nursing and allied health workforce in Australian public rheumatology departments is inadequate: a cross-sectional observational study

“…In addition, these conditions impact several facets of life such as work, sleep, diet, sexual function, and sport and exercise [ 2 – 5 ]. Guidelines recommend that optimal management of patients with rheumatological conditions should include multidisciplinary care, including contributions from nursing and allied health professionals [ 6 – 8 ]. Indeed, Australia’s Health Minister in 2023 outlined that the second of three foundations for healthcare reform in Australia is to enable more multidisciplinary and team-based approaches to healthcare [ 9 ].…”

A atuação fisioterapêutica em pacientes portadores da artrite reumatoide

“…A descoberta precoce da doença juntamente com os avanços científicos e tecnológicos podem gerar um tratamento mais efetivo, com uma maior probabilidade de controle dos sintomas na fase inicial e progressão da destruição articular1. Os cuidados com a AR se dá de forma farmacológica e não farmacológica, sempre tendo como objetivo a remissão ou a baixa atividade da doença, gerando uma melhor qualidade de vida para o indivíduo portador 4 .…”

“…As atividades da doença na fase inicial quando o tratamento se mostra benéfico, devem ser avaliadas a cada 1 a 3 meses, se os resultados estiverem de acordo com o esperado as avaliações acontecem a cada 3 a 6 meses, se o controle da doença seguir de forma estável o acompanhamento passa a ser semestralmente 4 .…”