2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis
(Part 2)
Last week, we started our discussion on the latest guidelines in the treatment of rheumatoid arthritis (RA) as provided by the American College of Rheumatism (ACR).
In our previous column, it was mentioned that the ACR periodically updates its guidelines when it comes to the treatment of the RA and the clinical practice guidelines for the management of RA.
It was also discussed last week that the ACR’s latest recommendations involve the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biologic DMARDs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs); glucocorticoids; and use of these medications in certain high-risk populations.
As we mentioned last week, the ACR expert panel drafted a population, intervention, comparator, and outcomes (PICO) questions and the review of evidence and literature was based on the PICO questions.
The core team defined the critical study outcome as disease activity for most PICO questions. As the ACR has, in a separate project, endorsed several disease activity measures for use in clinical practice.
The guideline does not define levels of disease activity or the instruments a clinician should use to measure it.
An in-person panel of 10 patients with RA, moderated by the project’s principal investigator, reviewed the evidence report and provided patient perspectives for consideration by the expert panel from the ACR.
The expert panel, composed of 13 clinicians and 2 patients, reviewed the reports and patient perspectives and voted on recommendation.
Several guiding principles, definitions, and assumptions were established a prior (Table 1). Because poor prognostic factors (11) have had less impact than other factors on prior RA treatment recommendations, they were not explicitly considered in formulating the PICO questions.
However, poor prognostic factors were considered as possible influential factors in physicians’ and patients’ decision-making when developing the recommendations.
This change in the set of recommendation was made because current disease activity, prior therapies used, and the presence of comorbidities were felt to be more relevant than disease duration for most treatment decisions.
The prompt diagnosis and treatment in RA is linked with improved results and thus have become an important principle in RA treatment.
The new set of recommendations is for the general RA patient population and assume that patients do not have contraindications to the options that are being considered,
Next week we will be revealing the results of the expert panel’s voting on the new set of recommendation regarding the treatment of RA.