EULAR issues updated rheumatoid arthritis management recommendations

July 3, 2013, European League Against Rheumatism

The European League Against Rheumatism (EULAR) has released updated recommendations for the management of RA. According to this latest guidance, treatment with disease-modifying anti-rheumatic drugs (DMARDs) should be initiated as soon as a diagnosis of RA is made, with the aim of reaching a target of remission or low disease activity in every patient.

As first-line treatment, EULAR recommends rheumatologists administer (MTX) or of MTX with other conventional synthetic DMARDs. Low-dose glucocorticoids should also be considered in combination with DMARDs for up to six months, but should be tapered as soon as clinically feasible.

"These recommendations were based on three extensive literature reviews of the efficacy and safety of biological and conventional DMARDs, and address a number of common misinterpretations of the 2010 guidelines," according to Professor Josef Smolen, Medical University of Vienna and Hietzing Hospital, Vienna. "As already stated in 2010, by advocating the use of synthetic DMARDs, rather than biologics, as the first-line treatment this approach avoids the over-treatment of 20-50% of patients with early RA, who will achieve the treatment target with such initial therapy" he concluded for the Task Force.

However, in patients failing to respond to this treatment within 6 months and when poor are present, biological DMARDs (TNF-inhibitors, abatacept or – or under certain circumstances rituximab) should be administered in combination with MTX.

The document further recommends that patients who have failed to respond to an initial biologic DMARD should receive another biologic DMARD. Patients who have failed to respond to an initial TNF-inhibitor may receive another TNF-inhibitor, or a biologic with an alternative mode of action. If biologic treatment has failed, tofacitinib may be considered where approved.

"Although the European Medicines Agency has not approved tofacitinib hitherto, it has been approved by the US Food and Drug Administration as well as in Japan and Russia. Having weighed up the evidence, the Task Force is convinced of its efficacy on clinical outcomes, function and structure. However, until more safety data are available and efficacy judged in clinical practice, tofacitinib is only recommended after at least one biological has failed – in fact, many Task Force members felt it should be used after two biological treatment failures," concluded Professor Smolen.

If a patient has achieved persistent remission, and after having tapered glucocorticoids, clinicians should consider tapering the biological DMARD, particularly if the treatment is in combination with a conventional synthetic DMARD. In cases of sustained long-term remission, cautious dose-reduction of conventional synthetic DMARDs should be considered.

In addition to the latest treatment recommendations, the guidelines also contain a number of over-arching principles addressing patient care. The guidelines recommend that the primary healthcare provider to RA patients should be a rheumatologist. In addition, monitoring of disease activity should take place every one to three months dependent on the disease activity, with alterations to therapy considered if no improvement is observed by three months post-, or if the target has not been reached by six months. Any initiation and adjustments of therapy should be made as a shared decision between patient and clinician, with factors including , progression of structural damage, co-morbidities and safety issues taken into account.

Explore further: ACR updates guidelines for use of DMARDs and biologic drugs in treating rheumatoid arthritis

More information: * These recommendations were developed by the EULAR Task Force on April 9, 2013; the exact wording is subject to change during the manuscript development process. The Task Force included Prof. Smolen, the chair; Dr.Landewé, the epidemiologist; rheumatologists from across Europe; patients; a health economist; and an infectious disease expert. The recommendations were based on three systematic literature reviews: one on synthetic DMARDs, one on biologic DMARD and one on safety issues related to treatment.

1. EULAR 2013 Rheumatoid Arthritis Management Recommendations, EULAR Data on File, 2013.

2. Chronic diseases and Health Promotion: Chronic Rheumatic Conditions, World Health Organisation. Available from: www.who.int/chp/topics/rheumatic/en/. Last accessed: May 2013

3. Michaud K, Wolfe F. Comorbidities in rheumatoid arthritis. Best Practice & Research Clinical Rheumatology. 2007; 21(5):885-906

Related Stories

ACR updates guidelines for use of DMARDs and biologic drugs in treating rheumatoid arthritis

April 2, 2012
The American College of Rheumatology (ACR) has released the 2012 recommendations for the use of disease-modifying antirheumatic drugs (DMARDs) and biologic agents in the treatment of rheumatoid arthritis (RA). The guidelines ...

Rheumatoid arthritis patients not taking their medications as prescribed

May 30, 2013
A new study conducted in an ethnically diverse and predominantly low income population found that only one-fifth of rheumatoid arthritis (RA) patients had an overall adherence rate to prescribed oral medications at 80% or ...

Abatacept as effective as adalimumab in rheumatoid arthritis

June 12, 2013
Data from AMPLE presented at EULAR 2013, the Annual Congress of the European League Against Rheumatism, demonstrate comparable efficacy and similar safety profiles between subcutaneous abatacept (ABA) and adalimumab (ADA).

Wide disparities in access to latest rheumatoid arthritis drugs across Europe

March 6, 2013
The cost of one year's treatment of rheumatoid arthritis with new generation drugs is more than the per capita gross domestic product of 26 European countries, reveals research published online in the Annals of the Rheumatic ...

Use of biologic therapies for inflammatory diseases does not appear to increase risk of shingles

April 19, 2013
Patients with rheumatoid arthritis (RA) who initiated use of anti-tumor necrosis factor therapies were not at a higher risk of developing herpes zoster (shingles), compared with patients who initiated nonbiologic treatment ...

Recommended for you

Osteoarthritis could be treated as two diseases, scientists reveal

January 10, 2018
Scientists at The University of Manchester have discovered that most people with osteoarthritis can be subdivided into two distinct disease groups, with implications for diagnosis and drug development.

US arthritis prevalence is much higher than current estimates

November 27, 2017
New research indicates that the prevalence of arthritis in the United States has been substantially underestimated, especially among adults

Maintaining sufficient vitamin D levels may help to prevent rheumatoid arthritis

November 20, 2017
Maintaining sufficient vitamin D levels may help to prevent the onset of inflammatory diseases like rheumatoid arthritis, research led by the University of Birmingham has discovered.

Old World monkeys could be key to a new, powerful rheumatoid arthritis therapy

November 16, 2017
In the quest for a new and more effective treatment for rheumatoid arthritis, researchers from the Keck School of Medicine of USC looked to a primate that mostly roams the land in Asia, the Middle East and Africa. It was ...

Study lists foods for fighting rheumatoid arthritis symptoms and progression

November 8, 2017
A list of food items with proven beneficial effects on the progression and symptoms of rheumatoid arthritis is provided in a new study published today in Frontiers in Nutrition. The authors suggest incorporating these foods ...

Prototype equipment can detect rheumatoid arthritis

September 28, 2017
According to a first clinical study published in the scientific journal Photoacoustics, the University of Twente and various European partners have designed a device that shows the difference between healthy fingers and arthritic ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.