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Practice Guideline
. 2021 Jul;73(7):924-939.
doi: 10.1002/acr.24596. Epub 2021 Jun 8.

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

Liana Fraenkel  1 , Joan M Bathon  2 , Bryant R England  3 , E William St Clair  4 , Thurayya Arayssi  5 , Kristine Carandang  6 , Kevin D Deane  7 , Mark Genovese  8 , Kent Kwas Huston  9 , Gail Kerr  10 , Joel Kremer  11 , Mary C Nakamura  12 , Linda A Russell  13 , Jasvinder A Singh  14 , Benjamin J Smith  15 , Jeffrey A Sparks  16 , Shilpa Venkatachalam  17 , Michael E Weinblatt  16 , Mounir Al-Gibbawi  18 , Joshua F Baker  19 , Kamil E Barbour  20 , Jennifer L Barton  21 , Laura Cappelli  22 , Fatimah Chamseddine  18 , Michael George  23 , Sindhu R Johnson  24 , Lara Kahale  18 , Basil S Karam  18 , Assem M Khamis  18 , Iris Navarro-Millán  25 , Reza Mirza  26 , Pascale Schwab  21 , Namrata Singh  27 , Marat Turgunbaev  28 , Amy S Turner  28 , Sally Yaacoub  18 , Elie A Akl  18
Affiliations
Practice Guideline

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

Liana Fraenkel et al. Arthritis Care Res (Hoboken). 2021 Jul.

Abstract

Objective: To develop updated guidelines for the pharmacologic management of rheumatoid arthritis.

Methods: We developed clinically relevant population, intervention, comparator, and outcomes (PICO) questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A voting panel comprising clinicians and patients achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.

Results: The guideline addresses treatment with disease-modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs, use of glucocorticoids, and use of DMARDs in certain high-risk populations (i.e., those with liver disease, heart failure, lymphoproliferative disorders, previous serious infections, and nontuberculous mycobacterial lung disease). The guideline includes 44 recommendations (7 strong and 37 conditional).

Conclusion: This clinical practice guideline is intended to serve as a tool to support clinician and patient decision-making. Recommendations are not prescriptive, and individual treatment decisions should be made through a shared decision-making process based on patients' values, goals, preferences, and comorbidities.

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References

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