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1. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update

Author

Smolen, J.S. (Josef S.), Landewé, R.B.M. (Robert), Bijlsma, J.W.J. (Hans), Burmester, G.R. (Gerd), Chatzidionysiou, K. (Katerina), Dougados, M. (Maxime), Nam, N. (Nguyen) van, Ramiro, S. (Sofia), Voshaar, M. (Marieke), Van Vollenhoven, R.F. (Ronald F.), Aletaha, D. (Daniel), Aringer, M. (Martin), Boers, M. (Maarten), Buckley, C.D., Buttgereit, F. (Frank), Bykerk, V.P. (Vivian), Cardiel, M. (Mario), Combe, B. (Bernard), Cutolo, M. (Maurizio), Van Eijk-Hustings, Y. (Yvonne), Emery, P. (Paul), Finckh, A. (Axel), Gabay, C. (Cem), Gómez-Reino, J.J. (Juan), Gossec, L. (Laure), Gottenberg, J.-E. (Jacques-Eric), Hazes, J.M.W. (Mieke), Huizinga, T.W.J. (Tom), Jani, M. (Meghna), Karateev, D. (Dmitry), Kouloumas, M. (Marios), Kvien, T.K. (Tore), Li, Z. (Zhanguo), Mariette, X. (Xavier), McInnes, I.B. (Iain), Mysler, E. (Eduardo), Nash, P. (Peter), Pavelka, K. (Karel), Poor, R.A. (Raymond), Richez, C. (Christophe), Riel, P.L.C.M. (Piet) van, Rubbert-Roth, A. (Andrea), Saag, K.G. (Kenneth), Da Silva, J. (Jose), Stamm, T. (Tanja), Takeuchi, T. (Tsutomu), Westhovens, R. (René), M. de Wit (Maarten), Van Der Heijde, D. (Désirée), Smolen, J.S. (Josef S.), Landewé, R.B.M. (Robert), Bijlsma, J.W.J. (Hans), Burmester, G.R. (Gerd), Chatzidionysiou, K. (Katerina), Dougados, M. (Maxime), Nam, N. (Nguyen) van, Ramiro, S. (Sofia), Voshaar, M. (Marieke), Van Vollenhoven, R.F. (Ronald F.), Aletaha, D. (Daniel), Aringer, M. (Martin), Boers, M. (Maarten), Buckley, C.D., Buttgereit, F. (Frank), Bykerk, V.P. (Vivian), Cardiel, M. (Mario), Combe, B. (Bernard), Cutolo, M. (Maurizio), Van Eijk-Hustings, Y. (Yvonne), Emery, P. (Paul), Finckh, A. (Axel), Gabay, C. (Cem), Gómez-Reino, J.J. (Juan), Gossec, L. (Laure), Gottenberg, J.-E. (Jacques-Eric), Hazes, J.M.W. (Mieke), Huizinga, T.W.J. (Tom), Jani, M. (Meghna), Karateev, D. (Dmitry), Kouloumas, M. (Marios), Kvien, T.K. (Tore), Li, Z. (Zhanguo), Mariette, X. (Xavier), McInnes, I.B. (Iain), Mysler, E. (Eduardo), Nash, P. (Peter), Pavelka, K. (Karel), Poor, R.A. (Raymond), Richez, C. (Christophe), Riel, P.L.C.M. (Piet) van, Rubbert-Roth, A. (Andrea), Saag, K.G. (Kenneth), Da Silva, J. (Jose), Stamm, T. (Tanja), Takeuchi, T. (Tsutomu), Westhovens, R. (René), M. de Wit (Maarten), and Van Der Heijde, D. (Désirée)

Abstract

Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recommendations address conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GC); biological (b) DMARDs (tumour necrosis factor (TNF)-inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, clazakizumab, sarilumab and sirukumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (Janus kinase (Jak) inhibitors tofacitinib, baricitinib). Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. Cost aspects were taken into consideration. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at >50% improvement within 3 and target attainment within 6 months. If this fails stratification is recommended. Without unfavourable prognostic markers, switching to-or adding-another csDMARDs (plus short-term GC) is suggested. In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered. For each recommendation, levels of evidence and Task Force agreement are provided, both mostly very high. These recommendations intend informing rheumatologists, patients, national rheumatolog

Published
2017
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2. EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis

Author

van Steenbergen, H.W. (Hanna W.), Aletaha, D. (Daniel), Beaart-van de Voorde, L.J.J. (Liesbeth J.J.), Brouwer, E. (Eric), Codreanu, C. (Catalin), Combe, B. (Bernard), Fonseca, J.E. (João E.), Hetland, M.L. (Merete L.), Humby, F. (Frances), Kvien, T.K. (Tore), Niedermann, K. (Karin), Nuño, L. (Laura), Oliver, S. (Sue), Rantapää-Dahlqvist, S. (Solbritt), Raza, K. (Karim), Schaardenburg, D. (Dirkjan) van, Schett, G. (Georg), De Smet, L. (Liesbeth), Szücs, G. (Gabriella), Vencovskỳ, J. (Jirí), Wiland, P. (Piotr), M. de Wit (Maarten), Landewé, R.L. (Robert L.), Helm-van Mil, A.H.M. (Annette) van der, van Steenbergen, H.W. (Hanna W.), Aletaha, D. (Daniel), Beaart-van de Voorde, L.J.J. (Liesbeth J.J.), Brouwer, E. (Eric), Codreanu, C. (Catalin), Combe, B. (Bernard), Fonseca, J.E. (João E.), Hetland, M.L. (Merete L.), Humby, F. (Frances), Kvien, T.K. (Tore), Niedermann, K. (Karin), Nuño, L. (Laura), Oliver, S. (Sue), Rantapää-Dahlqvist, S. (Solbritt), Raza, K. (Karim), Schaardenburg, D. (Dirkjan) van, Schett, G. (Georg), De Smet, L. (Liesbeth), Szücs, G. (Gabriella), Vencovskỳ, J. (Jirí), Wiland, P. (Piotr), M. de Wit (Maarten), Landewé, R.L. (Robert L.), and Helm-van Mil, A.H.M. (Annette) van der

Abstract

Background During the transition to rheumatoid arthritis (RA) many patients pass through a phase characterised by the presence of symptoms without clinically apparent synovitis. These symptoms are not well-characterised. This taskforce aimed to define the clinical characteristics of patients with arthralgia who are considered at risk for RA by experts based on their clinical experience. Methods The taskforce consisted of 18 rheumatologists, 1 methodologist, 2 patients, 3 health professionals and 1 research fellow. The process had three phases. In phase I, a list of parameters considered characteristic for clinically suspect arthralgia (CSA) was derived; the most important parameters were selected by a three-phased Delphi approach. In phase II, the experts evaluated 50 existing patients on paper, classified them as CSA/no-CSA and indicated their level of confidence. A provisional set of parameters was derived. This was studied for validation in phase III, where all rheumatologists collected patients with and without CSA from their outpatient clinics. Results The comprehensive list consisted of 55 parameters, of which 16 were considered most important. A multivariable model based on the data from phase II identified seven relevant parameters: symptom duration <1 year, symptoms of metacarpophalangeal (MCP) joints, morning stiffness duration =60 min, most severe symptoms in early morning, first-degree relative with RA, difficulty with making a fist and positive squeeze test of MCP joints. In phase III, the combination of these parameters was accurate in identifying patients with arthralgia who were considered at risk of developing RA (area under the receiver operating characteristic curve 0.92, 95% CI 0.87 to 0.96). Test characteristics for different cut-off points were determined. Conclusions A set of clinical characteristics for patients with arthralgia who are at risk of progression to RA was established.

Published
2017
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3. 2016 update of the EULAR recommendations for the management of early arthritis

Author

Combe, B. (Bernard), Landewé, R.B.M. (Robert), Daien, C.I. (Claire I.), Hua, C. (Charlotte), Aletaha, D. (Daniel), álvaro-Gracia, J.M. (Jose María), Bakkers, M. (Margôt), Brodin, N. (Nina), Burmester, G.R. (Gerd), Codreanu, C. (Catalin), Conway, R. (Richard), Dougados, M. (Maxime), Emery, P. (Paul), Ferraccioli, G. (Gianfranco), Fonseca, J. (Joao), Raza, K. (Karim), Silva-Fernández, L. (Lucía), Smolen, J.S. (Josef), Skingle, D. (Diana), Szekanecz, Z. (Zoltan), Kvien, T.K. (Tore), Helm-van Mil, A.H.M. (Annette) van der, Van Vollenhoven, R.F. (Ronald F.), Combe, B. (Bernard), Landewé, R.B.M. (Robert), Daien, C.I. (Claire I.), Hua, C. (Charlotte), Aletaha, D. (Daniel), álvaro-Gracia, J.M. (Jose María), Bakkers, M. (Margôt), Brodin, N. (Nina), Burmester, G.R. (Gerd), Codreanu, C. (Catalin), Conway, R. (Richard), Dougados, M. (Maxime), Emery, P. (Paul), Ferraccioli, G. (Gianfranco), Fonseca, J. (Joao), Raza, K. (Karim), Silva-Fernández, L. (Lucía), Smolen, J.S. (Josef), Skingle, D. (Diana), Szekanecz, Z. (Zoltan), Kvien, T.K. (Tore), Helm-van Mil, A.H.M. (Annette) van der, and Van Vollenhoven, R.F. (Ronald F.)

Abstract

Objectives Since the 2007 recommendations for the management of early arthritis have been presented, considerable research has been published in the field of early arthritis, mandating an update of the 2007 European League Against Rheumatism (EULAR) recommendations for management of early arthritis. Methods In accordance with the 2014 EULAR Standardised Operating Procedures, the expert committee pursued an approach that was based on evidence in the literature and on expert opinion. The committee involved 20 rheumatologists, 2 patients and 1 healthcare professional representing 12 European countries. The group defined the focus of the expert committee and target population, formulated a definition of 'management' and selected the research questions. A systematic literature research (SLR) was performed by two fellows with the help of a skilled librarian. A set of draft recommendations was proposed on the basis of the research questions and the results of the SLR. For each recommendation, the categories of evidence were identified, the strength of recommendations was derived and the level of agreement was determined through a voting process. Results The updated recommendations comprise 3 overarching principles and 12 recommendations for managing early arthritis. The selected statements involve the recognition of arthritis, referral, diagnosis, prognostication, treatment (information, education, pharmacological and non-pharmacological interventions), monitoring and strategy. Eighteen items were identified as relevant for future research. Conclusions These recommendations provide rheumatologists, general practitioners, healthcare professionals, patients and other stakeholders with an updated EULAR consensus on the entire management of early arthritis.

Published
2017
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4. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update

Author

Smolen, J.S. (Josef), Landewé, R.B.M. (Robert), Breedveld, F.C. (Ferdinand), Buch, T. (Thorsten), Burmester, G.R. (Gerd), Dougados, M. (Maxime), Emery, P. (Paul), Gaujoux-Viala, C. (Cécile), Gossec, L. (Laure), Nam, N. (Nguyen) van, Ramiro, S. (Sofia), Winthrop, K. (Kevin), M. de Wit (Maarten), Aletaha, D. (Daniel), Betteridge, N. (Neil), Bijlsma, J.W.J. (Hans), Boers, M. (Maarten), Buttgereit, F. (Frank), Combe, B. (Bernard), Cutolo, M. (Maurizio), Damjanov, N. (Nemanja), Hazes, J.M.W. (Mieke), Kouloumas, M. (Marios), Kvien, T.K. (Tore), Mariette, X. (Xavier), Pavelka, K. (Karel), Riel, P.L.C.M. (Piet) van, Rubbert-Roth, A. (Andrea), Scholte-Voshaar, M. (Marieke), Scott, D.L. (David), Sokka-Isler, T. (Tuulikki), Wong, J.B. (John), Heijde, D. (Desiree) van der, Smolen, J.S. (Josef), Landewé, R.B.M. (Robert), Breedveld, F.C. (Ferdinand), Buch, T. (Thorsten), Burmester, G.R. (Gerd), Dougados, M. (Maxime), Emery, P. (Paul), Gaujoux-Viala, C. (Cécile), Gossec, L. (Laure), Nam, N. (Nguyen) van, Ramiro, S. (Sofia), Winthrop, K. (Kevin), M. de Wit (Maarten), Aletaha, D. (Daniel), Betteridge, N. (Neil), Bijlsma, J.W.J. (Hans), Boers, M. (Maarten), Buttgereit, F. (Frank), Combe, B. (Bernard), Cutolo, M. (Maurizio), Damjanov, N. (Nemanja), Hazes, J.M.W. (Mieke), Kouloumas, M. (Marios), Kvien, T.K. (Tore), Mariette, X. (Xavier), Pavelka, K. (Karel), Riel, P.L.C.M. (Piet) van, Rubbert-Roth, A. (Andrea), Scholte-Voshaar, M. (Marieke), Scott, D.L. (David), Sokka-Isler, T. (Tuulikki), Wong, J.B. (John), and Heijde, D. (Desiree) van der

Published
2014
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5. The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: Phase 2 methodological report

Author

Neogi, T. (Tuhina), Aletaha, D. (Daniel), Silman, A.J. (Alan), Naden, R.L. (Raymond), Felson, D., Aggarwal, R. (Rohit), Bingham, C.O. (Clifton), Birnbaum, N.S. (Neal), Burmester, G.R. (Gerd), Bykerk, V.P. (Vivian), Cohen, M.D. (Marc), Combe, B. (Bernard), Costenbader, K.H. (Karen), Dougados, M. (Maxime), Emery, P. (Paul), Ferraccioli, G. (Gianfranco), Hazes, J.M.W. (Mieke), Hobbs, K. (Kathryn), Huizinga, T.W.J. (Tom), Kavanaugh, A. (Arthur), Kay, J. (Jonathan), Khanna, D. (Dinesh), Kvien, T.K. (Tore), Laing, T. (Timothy), Liao, K. (Katherine), Mease, P. (Philip), Ménard, H.A. (Henri), Moreland, L.W. (Larry), Nair, R. (Raj), Pincus, T. (Theodore), Ringold, S. (Sarah), Smolen, J.S. (Josef), Stanislawska-Biernat, E. (Ewa), Symmons, D. (Deborah), Tak, P.P. (Paul), Upchurch, K.S. (Katherine), Vencovský, J. (Jiří), Wolfe, F. (Frederick), Hawker, G. (Gillian), Neogi, T. (Tuhina), Aletaha, D. (Daniel), Silman, A.J. (Alan), Naden, R.L. (Raymond), Felson, D., Aggarwal, R. (Rohit), Bingham, C.O. (Clifton), Birnbaum, N.S. (Neal), Burmester, G.R. (Gerd), Bykerk, V.P. (Vivian), Cohen, M.D. (Marc), Combe, B. (Bernard), Costenbader, K.H. (Karen), Dougados, M. (Maxime), Emery, P. (Paul), Ferraccioli, G. (Gianfranco), Hazes, J.M.W. (Mieke), Hobbs, K. (Kathryn), Huizinga, T.W.J. (Tom), Kavanaugh, A. (Arthur), Kay, J. (Jonathan), Khanna, D. (Dinesh), Kvien, T.K. (Tore), Laing, T. (Timothy), Liao, K. (Katherine), Mease, P. (Philip), Ménard, H.A. (Henri), Moreland, L.W. (Larry), Nair, R. (Raj), Pincus, T. (Theodore), Ringold, S. (Sarah), Smolen, J.S. (Josef), Stanislawska-Biernat, E. (Ewa), Symmons, D. (Deborah), Tak, P.P. (Paul), Upchurch, K.S. (Katherine), Vencovský, J. (Jiří), Wolfe, F. (Frederick), and Hawker, G. (Gillian)

Abstract

Objective. The American College of Rheumatology and the European League Against Rheumatism have developed new classification criteria for rheumatoid arthritis (RA). The aim of Phase 2 of the development process was to achieve expert consensus on the clinical and laboratory variables that should contribute to the final criteria set. Methods. Twenty-four expert RA clinicians (12 from Europe and 12 from North America) participated in Phase 2. A consensus-based decision analysis approach was used to identify factors (and their relative weights) that influence the probability of "developing RA," complemented by data from the Phase 1 study. Patient case scenarios were used to identify and reach consensus on factors important in determining the probability of RA development. Decision analytic software was used to derive the relative weights for each of the factors and their categories, using choice-based conjoint analysis. Results. The expert panel agreed that the new classification criteria should be applied to individuals with undifferentiated inflammatory arthritis in whom at least 1 joint is deemed by an expert assessor to be swollen, indicating definite synovitis. In this clinical setting, they identified 4 additional criteria as being important: number of joints involved and site of involvement, serologic abnormality, acute-phase response, and duration of symptoms in the involved joints. These criteria were consistent with those identified in the Phase 1 data-driven approach. Conclusion. The consensus-based, decision analysis approach used in Phase 2 complemented the Phase 1 efforts. The 4 criteria and their relative weights form the basis of the final criteria set.

Published
2010
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6. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative

Author

Aletaha, D. (Daniel), Neogi, T. (Tuhina), Silman, A.J. (Alan), Funovits, J. (Julia), Felson, D., Bingham, C.O. (Clifton), Birnbaum, N.S. (Neal), Burmester, G.R. (Gerd), Bykerk, V.P. (Vivian), Cohen, M.D. (Marc), Combe, B. (Bernard), Costenbader, K.H. (Karen), Dougados, M. (Maxime), Emery, P. (Paul), Ferraccioli, G. (Gianfranco), Hazes, J.M.W. (Mieke), Hobbs, K. (Kathryn), Huizinga, T.W.J. (Tom), Kavanaugh, A. (Arthur), Kay, J. (Jonathan), Kvien, T.K. (Tore), Laing, T. (Timothy), Mease, P. (Philip), Ménard, H.A. (Henri), Moreland, L.W. (Larry), Naden, R.L. (Raymond), Pincus, T. (Theodore), Smolen, J.S. (Josef), Stanislawska-Biernat, E. (Ewa), Symmons, D. (Deborah), Tak, P.P. (Paul), Upchurch, K.S. (Katherine), Vencovský, J. (Jiří), Wolfe, F. (Frederick), Hawker, G. (Gillian), Aletaha, D. (Daniel), Neogi, T. (Tuhina), Silman, A.J. (Alan), Funovits, J. (Julia), Felson, D., Bingham, C.O. (Clifton), Birnbaum, N.S. (Neal), Burmester, G.R. (Gerd), Bykerk, V.P. (Vivian), Cohen, M.D. (Marc), Combe, B. (Bernard), Costenbader, K.H. (Karen), Dougados, M. (Maxime), Emery, P. (Paul), Ferraccioli, G. (Gianfranco), Hazes, J.M.W. (Mieke), Hobbs, K. (Kathryn), Huizinga, T.W.J. (Tom), Kavanaugh, A. (Arthur), Kay, J. (Jonathan), Kvien, T.K. (Tore), Laing, T. (Timothy), Mease, P. (Philip), Ménard, H.A. (Henri), Moreland, L.W. (Larry), Naden, R.L. (Raymond), Pincus, T. (Theodore), Smolen, J.S. (Josef), Stanislawska-Biernat, E. (Ewa), Symmons, D. (Deborah), Tak, P.P. (Paul), Upchurch, K.S. (Katherine), Vencovský, J. (Jiří), Wolfe, F. (Frederick), and Hawker, G. (Gillian)

Abstract

Objective. The 1987 American College of Rheumatology (ACR; formerly, the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticized for their lack of sensitivity in early disease. This work was undertaken to develop new classification criteria for RA. Methods. A joint working group from the ACR and the European League Against Rheumatism developed, in 3 phases, a new approach to classifying RA. The work focused on identifying, among patients newly presenting with undifferentiated inflammatory synovitis, factors that best discriminated between those who were and those who were not at high risk for persistent and/or erosive disease - this being the appropriate current paradigm underlying the disease construct "rheumatoid arthritis." Results. In the new criteria set, classification as "definite RA" is based on the confirmed presence of synovitis in at least 1 joint, absence of an alternative diagnosis that better explains the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in 4 domains: number and site of involved joints (score range 0-5), serologic abnormality (score range 0-3), elevated acute-phase response (score range 0-1), and symptom duration (2 levels; range 0-1). Conclusion. This new classification system redefines the current paradigm of RA by focusing on features at earlier stages of disease that are associated with persistent and/or erosive disease, rather th

Published
2010
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