2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis
(Part 3)
We now continue our discussion on the American College of Rheumatology (ACR) guidelines for the treatment of rheumatoid arthritis (RA).
Then guideline follows the ACR guideline development process and ACR policy guiding the management of conflicts of interest and disclosures. The ACR’s methods in the formulation of the guidelines abide by certain rules to ensure transparency.
Moreover, the ACR experts came up with clinical population, intervention, comparator, and outcomes (PICO) questions. The literature review team of the ACR performed systematic literature reviews for the PICO questions, chosen and evaluated individual studies and decided the quality of the pieces of evidence available for each result, and produced the evidence report.
The core team of experts defined the study results as disease activity for most PICO questions.
For PICO questions,the critical results include issues on disease flare and subsequent return to the treatment target. Physical function, radiographic progression, quality of life, other patient-reported outcome measures, and adverse events were defined as important results.
Other clinical results were defined pertaining to select high-risk conditions.
The panel considered these estimates from a societal perspective, which is based on the list price.
Several guiding principles, definitions, and assumptions were established before hand.
The change in RA guidelines was made because of current disease activity, prior therapies used, and the presence of co-morbidities were felt to be more relevant than disease duration for most treatment decisions. However, early diagnosis and treatment in RA are associated with improved prognosis and recovery and are thus an important overarching principle in its management.
We will continue next week our discussion on the guidelines by focusing on the outcome and main recommendations presented by the expert panel of the ACR.