2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis

(Part 1)

This week we start another topic which involves the latest guidelines in the treatment of rheumatoid arthritis.

The American College of Rheumatology (ACR) regularly updates clinical practice guidelines for the management of rheumatoid arthritis (RA). The most recent update came in 2015.

The present recommendations involve the following: 1) conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biologic DMARDs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs); 2) glucocorticoids; and 3) use of these medications in certain high-risk populations.

The use of vaccines and nonpharmacologic treatment approaches will be covered in another set of guidelines.

Each recommendation is qualified as being strong or conditional, this means, strong recommendations are those for which the panel is highly confident that the recommended option favorably balances the expected benefits and risks for  majority of patients.

Moreover, the conditional recommendations are those, which the experts are less confident about the potential benefits outweigh the risks. 

The public needs to understand that a recommendation can be conditional because of low or very low certainty in the evidence supporting one option over another.

It is possible that the reason for the low confidence is due to varied patient preferences in terms of treatments are concerned.

The guideline follows certain protocol set by the ACR and subsequent guidelines that manages conflict of interest.

The ACR core leadership team drafted clinical population, intervention, comparator, and outcomes (PICO) questions. On the other hand, the literature review team was tasked to create systematic literature reviews for the PICO questions, selected, evaluated and studied the pieces of evidence which are available.

The core team defined the results as disease activity for most PICO questions.

Next week we will be making a deeper dive on the new guidelines on the management of RA as recommended by the ACR.