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3. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force

Author

Smolen, Josef S, Breedveld, Ferdinand C, Burmester, Gerd R, Bykerk, Vivian, Dougados, Maxime, Emery, Paul, Kvien, Tore K, Navarro-Compán, M Victoria, Oliver, Susan, Schoels, Monika, Scholte-Voshaar, Marieke, Stamm, Tanja, Stoffer, Michaela, Takeuchi, Tsutomu, Aletaha, Daniel, Andreu, Jose Louis, Aringer, Martin, Bergman, Martin, Betteridge, Neil, Bijlsma, Hans, Burkhardt, Harald, Cardiel, Mario, Combe, Bernard, Durez, Patrick, Fonseca, Joao Eurico, Gibofsky, Alan, Gomez-Reino, Juan J, Graninger, Winfried, Hannonen, Pekka, Haraoui, Boulos, Kouloumas, Marios, Landewe, Robert, Martin-Mola, Emilio, Nash, Peter, Ostergaard, Mikkel, Östör, Andrew, Richards, Pam, Sokka-Isler, Tuulikki, Thorne, Carter, Tzioufas, Athanasios G, van Vollenhoven, Ronald, de Wit, Martinus, and van der Heijde, Desirée

Published
2016
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6. Targeted treatment with a combination of traditional DMARDs produces excellent clinical and radiographic long-term outcomes in early rheumatoid arthritis regardless of initial infliximab. The 5-year follow-up results of a randomised clinical trial, the NEO-RACo trial

Author

Rantalaiho, Vappu, Kautiainen, Hannu, Korpela, Markku, Hannonen, Pekka, Kaipiainen-Seppänen, Oili, Möttönen, Timo, Kauppi, Markku, Karjalainen, Anna, Laiho, Kari, Laasonen, Leena, Hakola, Mikko, Peltomaa, Ritva, Leirisalo-Repo, Marjatta, Alasaarela, Eeva, Blåfield, Harri, Eklund, Kari K, Ilva, Kirsti, Julkunen, Heikki, Kononoff, Aulikki, Krogerus, Maija-Liisa, Luosujärvi, Riitta, Luukkainen, Reijo, Malmi, Timo, Niinisalo, Helena, Paimela, Leena, Puolakka, Kari, Pöllänen, Jari, Uusitalo, Tea, Uutela, Toini, Valleala, Heikki, Vuori, Kaisa, Moilanen, Eeva, Nieminen, Riina, Vuolteenah, Katariina, Leirisalo-Repo, Marjatta, Möttönen, Timo, Korpela, Markku, Kauppi, Markku, Kaipiainen-Seppänen, Oili, and Luosujärv, Riitta

Published
2014
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9. Infliximab for 6 months added on combination therapy in early rheumatoid arthritis: 2-year results from an investigator-initiated, randomised, double-blind, placebo-controlled study (the NEO-RACo Study)

Author

Leirisalo-Repo, Marjatta, Kautiainen, Hannu, Laasonen, Leena, Korpela, Markku, Kauppi, Markku J, Kaipiainen-Seppänen, Oili, Luosujärvi, Riitta, Luukkainen, Reijo, Karjalainen, Anna, Blåfield, Harri, Uutela, Toini, Ilva, Kirsti, Julkunen, Heikki A, Paimela, Leena, Puolakka, Kari, Moilanen, Eeva, Hannonen, Pekka J, Möttönen, Timo, Alasaarela, Eeva, Eklund, Kari K, Hakola, Mikko, Kononoff, Aulikki, Krogerus, Maija-Liisa, Laiho, Kari, Malmi, Timo, Niinisalo, Helena, Peltomaa, Ritva, Pöllänen, Jari, Uusitalo, Tea, Valleala, Heikki, Vuori, Kaisa, Nieminen, Riina, and Vuolteenaho, Katariina

Published
2013
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12. Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative

Author

Whittle, Samuel L., Colebatch, Alexandra N., Buchbinder, Rachelle, Edwards, Christopher J., Adams, Karen, Englbrecht, Matthias, Hazlewood, Glen, Marks, Jonathan L., Radner, Helga, Ramiro, Sofia, Richards, Bethan L., Tarner, Ingo H., Aletaha, Daniel, Bombardier, Claire, Landewé, Robert B., Müller-Ladner, Ulf, Bijlsma, Johannes W. J., Branco, Jaime C., Bykerk, Vivian P., da Rocha Castelar Pinheiro, Geraldo, Catrina, Anca I., Hannonen, Pekka, Kiely, Patrick, Leeb, Burkhard, Lie, Elisabeth, Martinez-Osuna, Píndaro, Montecucco, Carlomaurizio, Østergaard, Mikkel, Westhovens, Rene, Zochling, Jane, and van der Heijde, Désirée

Published
2012
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30. Delay to Institution of Therapy and Induction of Remission Using Single-Drug or Combination–Disease-Modifying Antirheumatic Drug Therapy in Early Rheumatoid Arthritis

Author

Möttönen, Timo, Hannonen, Pekka, Korpela, Markku, Nissilä, Martti, Kautiainen, Hannu, Ilonen, Jorma, Laasonen, Leena, Kaipiainen-Seppänen, Oili, Franzen, Per, Helve, Tapani, Koski, Juhani, Gripenberg-Gahmberg, Marianne, Myllykangas-Luosujärvi, Riitta, and Leirisalo-Repo, Marjatta

Published
2002
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32. Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study

Author

Gauffin Jarno, Hankama Tiina, Kautiainen Hannu, Hannonen Pekka, and Haanpää Maija

Subjects
Neurology. Diseases of the nervous system, RC346-429
Abstract

Abstract Backround Fibromyalgia has a plethorae of symptoms, which can be confusing and even misleading. Accurate evaluation is necessary when patients with fibromyalgia are treated. Different types of instruments are available for the clinicians to supplement evaluation. Our objective was to study the applicability of the PainDETECT instrument to screen neuropathic pain in patients with fibromyalgia. Methods 158 patients with primary fibromyalgia underwent a neurological examination including bedside sensory testing. They also fulfilled four questionnaires: PainDETECT, Beck depression inventory IA (BDI IA), Fibromyalgia Impact Questionnaire (FIQ) and a self-made questionnaire regarding present pain and pain relieving methods of the patients. The results of the clinical evaluation and questionnaires were then compared. Results Clinically verified neuropathic pain was diagnosed in 53/158 [34% (95% Cl: 26 to 41)] patients. The ROC curve achieved a maximum Youden´s index at score of 17 when sensitivity was 0.79 (95% Cl: 0.66 to 0.89) and specificity 0.53 (95% Cl: 0.43 to 0.63). The PainDETECT total score (OR: 1.14 95% Cl: 1.06 to 1.22), FM as the worst current pain (OR: 0.31; 95% 0.16 to 0.62), body mass index (BMI) (OR: 1.05; 95% Cl: 1.00 to 1.11) and the intensity of current pain (OR: 1.20; 95% Cl: 1.01 to 1.41) were significantly associated with the presence of neuropathic pain in univariate analyses. Conclusion This study highlights the importance of thorough clinical examination. The Neuropathic pain screening tool PainDETECT is not as useful in patients with fibromyalgia as in patients with uncompromised central pain control.

Published
2013
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39. Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomised trial

Author

Mottonen, Timo, Hannonen, Pekka, Leirisalo-Repo, Marjatta, Nissila, Martti, Kautiainen, Hannu, Korpela, Markku, Laasonen, Leena, Julkunen, Heikki, Luukkainen, Reijo, Vuori, Kaisa, Paimela, Leena, Blafield, Harri, Hakala, Markku, Ilva, Kirsti, Yli-Kerttula, Urpo, Puolakka, Kari, Jarvinen, Pentti, Hakola, Mikko, Piirainen, Heikki, Ahonen, Jari, Palvimaki, Ilppo, Forsberg, Sinikka, Koota, Kalevi, and Friman, Claes

Published
1999

41. Early Targeted Combination Treatment With Conventional Synthetic Disease-Modifying Antirheumatic Drugs and Long-Term Outcomes in Rheumatoid Arthritis: Ten-Year Follow-Up Results of a Randomized Clinical Trial

Author

NEO-RACo Study Group, Rantalaiho, Vappu, Sandström, Tia, Koski, Juhani, Hannonen, Pekka, Mottonen, Timo, Kaipiainen-Seppänen, Oili, Yli-Kerttula, Timo, Kauppi, Markku J., Uutela, Toini, Malmi, Timo, Julkunen, Heikki, Laasonen, Leena, Kautiainen, Hannu, Leirisalo-Repo, Marjatta, Faculty of Medicine, University of Helsinki, Clinicum, HUS Helsinki and Uusimaa Hospital District, HYKS erva, Päijät-Häme Welfare Consortium, Department of Medicine, Department of Diagnostics and Therapeutics, HUS Medical Imaging Center, Reumatologian yksikkö, and HUS Internal Medicine and Rehabilitation

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Combination therapy, Prednisolone, Arthritis, Placebo, THERAPY, law.invention, Arthritis, Rheumatoid, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Randomized controlled trial, Double-Blind Method, law, Internal medicine, Adalimumab, medicine, Humans, COHORT, Finland, 030203 arthritis & rheumatology, Biological Products, business.industry, REMISSION, Induction Chemotherapy, Middle Aged, medicine.disease, Infliximab, 3. Good health, Treatment Outcome, 3121 General medicine, internal medicine and other clinical medicine, SAFETY, Rheumatoid arthritis, Antirheumatic Agents, Drug Therapy, Combination, Female, business, ADALIMUMAB, medicine.drug, Follow-Up Studies
Abstract

Objective The short-term outcomes of remission-targeted treatments of rheumatoid arthritis (RA) are well-established, but the long-term success of such strategies is speculative, as is the role of early add-on biologics. We assessed the 10-year outcomes of patients with early RA treated with initial remission-targeted triple combination of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), 7.5-mg prednisolone, and additional infliximab (IFX) or placebo infusions. Methods Ninety-nine patients with early, DMARD-naive RA were treated with a triple combination of csDMARDs and prednisolone and randomized to double-blind receipt of infusions of either IFX (the Finnish Rheumatoid Arthritis Combination Therapy Trial [FIN-RACo] + IFX) or placebo (FIN-RACo + placebo) during the first 6 months. After 2 years, the treatment strategies became unrestricted, but the treatment goal was strict remission in the TNF-Blocking Therapy in Combination With Disease-Modifying Antirheumatic Drugs in Early Rheumatoid Arthritis (NEO-RACo) study. At 10 years, the clinical and radiographic outcomes and the drug treatments used between 5 and 10 years were assessed. Results Ninety patients (91%) were followed after 2 years, 43 in the FIN-RACo + IFX and 47 in the FIN-RACo + placebo group. At 10 years, the respective proportions of patients in strict NEO-RACo remission and in Disease Activity Score using 28 joints remission in the FIN-RACo + IFX and FIN-RACo + placebo groups were 46% and 38% (P = 0.46) and 82% and 72% (P = 0.29), respectively. The mean total Sharp/van der Heijde score was 9.8 in the FIN-RACo + IFX and 7.3 in the FIN-RACo + placebo group (P = 0.34). During the 10-year follow-up, 26% of the FIN-RACo + IFX group and 30% of the FIN-RACo + placebo group had received biologics (P = 0.74). Conclusion In early RA, excellent results can be maintained up until 10 years in most patients treated with initial combination csDMARDs and remission-targeted strategy, regardless of initial IFX/placebo infusions.

Published
2018

43. Is seronegative rheumatoid arthritis true rheumatoid arthritis? A nationwide cohort study.

Author

Paalanen, Kirsi, Puolakka, Kari, Nikiphorou, Elena, Hannonen, Pekka, and Sokka, Tuulikki

Subjects
REPORTING of diseases, PSORIATIC arthritis, NOSOLOGY, INFLAMMATORY bowel diseases, CONFIDENCE intervals, IDENTIFICATION, DISEASE incidence, PATIENTS, SPONDYLOARTHROPATHIES, RHEUMATOID arthritis
Abstract

Objectives The classification of seronegative arthritides can be challenging. Our aim was to examine the incidence of SpA diagnosis among patients initially diagnosed as seronegative RA. Methods Using nationwide Finnish registers from social insurance institutions, we identified all adult patients who were diagnosed with incident seronegative RA [International Classification of Diseases (ICD)-10 code M06] from 1 January 2000 to 31 December 2014. The patients whose diagnoses subsequently changed to the ICD-10 codes of SpA (M07, M45, M46, K50 and K51) were identified in the national care register, until 31 December 2016. Results A total of 9784 adult seronegative RA patients were identified. Of these, 564 patients had their diagnosis subsequently changed to SpA: 275 (48.7%) patients with PsA, 245 (43.4%) patients with axial SpA and 44 (7.8%) patients with diagnoses related to IBD. The cumulative incidence of SpA diagnoses in 15 years was 10.4% (95% CI 8.9, 12.1) and 8.1% (95% CI 7.1, 9.3) in men and women, respectively. Conclusion This study calls for vigilance in seronegative RA patients, especially those with more atypical presentations, since the diagnosis could change. The possibility of SpA diagnosis should be considered and specifically looked for, as this could impact on management and response to treatment. [ABSTRACT FROM AUTHOR]

Published
2021
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45. Does parvovirus B19 have a role in rheumatoid arthritis?

Author

Nikkari, Simo, Luukkainen, Reijo, Mottonen, Timo, Meurman, Olli, Hannonen, Pekka, Skurnik, Mikael, and Toivanen, Paavo

Subjects
Rheumatoid arthritis -- Risk factors, Parvovirus infections -- Physiological aspects, Health
Abstract

Parvovirus B19 infection does not appear to cause rheumatoid arthritis (RA). Rheumatoid arthritis is a degenerative disease that has an autoimmune component. Parvovirus B19 infection is associated with joint abnormalities. Synovial fluid, synovial fluid cells and blood serum samples from 142 patients with early RA were analyzed for evidence of parvovirus B19 infection. Synovial fluid is produced by and lubricates the joints. Analysis of blood samples revealed evidence of recent parvovirus B19 infection in four of 135 RA patients. No parvovirus DNA was detected in 40 blood serum samples, 18 synovial fluid samples or 21 synovial fluid cell samples from RA patients. Three of the four patients who tested positive for parvovirus B19 infection were re-classified as having B19 arthropathies. The fourth patient remained classified as having RA.

Published
1994

46. Cervical Spine Involvement among Patients with Rheumatoid Arthritis Treated Actively with Treat-to-target Strategy: 10-year Results of the NEO-RACo Study.

Author

Sandström, Tia, Rantalaiho, Vappu, Yli-Kerttula, Timo, Kautiainen, Hannu, Malmi, Timo, Karjalainen, Anna, Uusitalo, Tea, Julkunen, Heikki, Kaipiainen-Seppänen, Oili, Paimela, Leena, Puolakka, Kari, Uutela, Toini, Möttönen, Timo, Hannonen, Pekka, Leirisalo-Repo, Marjatta, Laasonen, Leena, Kauppi, Markku, and NEO-RACo Study Group

Published
2020
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47. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force

Author

Smolen, Josef S., Breedveld, Ferdinand C., Burmester, Gerd R., Bykerk, Vivian, Dougados, Maxime, Emery, Paul, Kvien, Tore K., Navarro-Compán, M. Victoria, Oliver, Susan, Schoels, Monika, Scholte-Voshaar, Marieke, Stamm, Tanja, Stoffer, Michaela, Takeuchi, Tsutomu, Aletaha, Daniel, Andreu, Jose Louis, Aringer, Martin, Bergman, Martin, Bijlsma, Hans, Burkhardt, Harald, Cardiel, Mario, Combe, Bernard, Durez, Patrick, Fonseca, Joao Eurico, Gibofsky, Alan, Gomez-Reino, Juan J., Graninger, Winfried, Hannonen, Pekka, Haraoui, Boulos, Kouloumas, Marios, Landewe, Robert, Martin-Mola, Emilio, Nash, Peter, Ostergaard, Mikkel, Östör, Andrew, Richards, Pam, Sokka-Isler, Tuulikki, Thorne, Carter, Tzioufas, Athanasios G., Vollenhoven, Ronald van, Wit, Martinus de, and Heijde, Desirée van der

Subjects
ddc:610
Abstract

Background Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. Objective To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. Methods A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. Results The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1–3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (≥9/10). Conclusions The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.

Published
2015

48. Early Targeted Combination Treatment With Conventional Synthetic Disease-Modifying Antirheumatic Drugs and Long-Term Outcomes in Rheumatoid Arthritis: Ten-Year Follow-Up Results of a Randomized Clinical Trial.

Author

Rantalaiho, Vappu, Sandström, Tia, Koski, Juhani, Hannonen, Pekka, Möttönen, Timo, Kaipiainen‐Seppänen, Oili, Yli‐Kerttula, Timo, Kauppi, Markku J., Uutela, Toini, Malmi, Timo, Julkunen, Heikki, Laasonen, Leena, Kautiainen, Hannu, Leirisalo‐Repo, Marjatta, Kaipiainen-Seppänen, Oili, Yli-Kerttula, Timo, Leirisalo-Repo, Marjatta, and NEO-RACo Study Group

Subjects
PREDNISOLONE, BIOLOGICAL products, COMBINATION drug therapy, TIME, ANTIRHEUMATIC agents, TREATMENT effectiveness, RANDOMIZED controlled trials, RHEUMATOID arthritis, BLIND experiment, RESEARCH funding, STATISTICAL sampling
Abstract

Objective: The short-term outcomes of remission-targeted treatments of rheumatoid arthritis (RA) are well-established, but the long-term success of such strategies is speculative, as is the role of early add-on biologics. We assessed the 10-year outcomes of patients with early RA treated with initial remission-targeted triple combination of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), 7.5-mg prednisolone, and additional infliximab (IFX) or placebo infusions.Methods: Ninety-nine patients with early, DMARD-naive RA were treated with a triple combination of csDMARDs and prednisolone and randomized to double-blind receipt of infusions of either IFX (the Finnish Rheumatoid Arthritis Combination Therapy Trial [FIN-RACo] + IFX) or placebo (FIN-RACo + placebo) during the first 6 months. After 2 years, the treatment strategies became unrestricted, but the treatment goal was strict remission in the TNF-Blocking Therapy in Combination With Disease-Modifying Antirheumatic Drugs in Early Rheumatoid Arthritis (NEO-RACo) study. At 10 years, the clinical and radiographic outcomes and the drug treatments used between 5 and 10 years were assessed.Results: Ninety patients (91%) were followed after 2 years, 43 in the FIN-RACo + IFX and 47 in the FIN-RACo + placebo group. At 10 years, the respective proportions of patients in strict NEO-RACo remission and in Disease Activity Score using 28 joints remission in the FIN-RACo + IFX and FIN-RACo + placebo groups were 46% and 38% (P = 0.46) and 82% and 72% (P = 0.29), respectively. The mean total Sharp/van der Heijde score was 9.8 in the FIN-RACo + IFX and 7.3 in the FIN-RACo + placebo group (P = 0.34). During the 10-year follow-up, 26% of the FIN-RACo + IFX group and 30% of the FIN-RACo + placebo group had received biologics (P = 0.74).Conclusion: In early RA, excellent results can be maintained up until 10 years in most patients treated with initial combination csDMARDs and remission-targeted strategy, regardless of initial IFX/placebo infusions. [ABSTRACT FROM AUTHOR]

Published
2019
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49. Long-term outcomes of destructive seronegative (rheumatoid) arthritis - description of four clinical cases

Author

Nikiphorou, Elena, Sjöwall, Christopher, Hannonen, Pekka, Rannio, Tuomas, Sokka, Tuulikki, Nikiphorou, Elena, Sjöwall, Christopher, Hannonen, Pekka, Rannio, Tuomas, and Sokka, Tuulikki

Abstract

Background: Seronegative rheumatoid arthritis is associated with a milder course of progression compared to seropositive disease. However, long-term follow-up data of the clinical course of seronegative rheumatoid arthritis are sparse. Here we describe four cases with a rare disease entity of aggressive destructive seronegative (rheumatoid) arthritis with 20-35 years of follow-up. Case presentation: The four cases are women with an initial presentation of seronegative rheumatoid arthritis in 1980-1996 and have received disease-modifying anti-rheumatic drugs since the diagnosis. In all cases, the condition has been refractory to treatments and evolved into a severe disease with destructions of the wrists, sub-talar and ankle joints, as well as large joints but not small joints of fingers and toes. All cases are negative with regard to rheumatoid factor, anti-cyclic citrullinated peptide antibodies and antibodies against carbamylated proteins. Conclusions: This report adds to the existing literature, making the reader aware of this sub-type of inflammatory arthritis which despite being seronegative, can have devastating disease consequences. The report highlights the need for further research into this field in order to better understand this disease sub-type, the pathogenesis, disease course and outcomes., Funding Agencies|Swedish Society for Medical Research; EULAR Scientific Training bursary

Published
2016
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50. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force.

Author

UCL - SSS/IREC/RUMA - Pôle de Pathologies rhumatismales, UCL - (SLuc) Service de rhumatologie, Smolen, Josef S, Breedveld, Ferdinand C, Burmester, Gerd R, Bykerk, Vivian, Dougados, Maxime, Emery, Paul, Kvien, Tore K, Navarro-Compán, M Victoria, Oliver, Susan, Schoels, Monika, Scholte-Voshaar, Marieke, Stamm, Tanja, Stoffer, Michaela, Takeuchi, Tsutomu, Aletaha, Daniel, Andreu, Jose Louis, Aringer, Martin, Bergman, Martin, Betteridge, Neil, Bijlsma, Hans, Burkhardt, Harald, Cardiel, Mario, Combe, Bernard, Durez, Patrick, Fonseca, Joao Eurico, Gibofsky, Alan, Gomez-Reino, Juan J, Graninger, Winfried, Hannonen, Pekka, Haraoui, Boulos, Kouloumas, Marios, Landewe, Robert, Martin-Mola, Emilio, Nash, Peter, Ostergaard, Mikkel, Östör, Andrew, Richards, Pam, Sokka-Isler, Tuulikki, Thorne, Carter, Tzioufas, Athanasios G, van Vollenhoven, Ronald, de Wit, Martinus, van der Heijde, Desirée, UCL - SSS/IREC/RUMA - Pôle de Pathologies rhumatismales, UCL - (SLuc) Service de rhumatologie, Smolen, Josef S, Breedveld, Ferdinand C, Burmester, Gerd R, Bykerk, Vivian, Dougados, Maxime, Emery, Paul, Kvien, Tore K, Navarro-Compán, M Victoria, Oliver, Susan, Schoels, Monika, Scholte-Voshaar, Marieke, Stamm, Tanja, Stoffer, Michaela, Takeuchi, Tsutomu, Aletaha, Daniel, Andreu, Jose Louis, Aringer, Martin, Bergman, Martin, Betteridge, Neil, Bijlsma, Hans, Burkhardt, Harald, Cardiel, Mario, Combe, Bernard, Durez, Patrick, Fonseca, Joao Eurico, Gibofsky, Alan, Gomez-Reino, Juan J, Graninger, Winfried, Hannonen, Pekka, Haraoui, Boulos, Kouloumas, Marios, Landewe, Robert, Martin-Mola, Emilio, Nash, Peter, Ostergaard, Mikkel, Östör, Andrew, Richards, Pam, Sokka-Isler, Tuulikki, Thorne, Carter, Tzioufas, Athanasios G, van Vollenhoven, Ronald, de Wit, Martinus, and van der Heijde, Desirée

Abstract

BACKGROUND: Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. OBJECTIVE: To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. METHODS: A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. RESULTS: The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the di

Published
2016

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