2018 Chinese Guidelines for the Diagnosis and Treatment of Rheumatoid Arthritis

Abstract

A multidisciplinary guideline development group was established to formulate this evidence-based diagnosis and treatment guidelines for rheumatoid arthritis (RA) in China. The grading of recommendations, assessment, development, and evaluation (GRADE) system was used to rate the quality of the evidence and the strength of recommendations, which were derived from research articles and guided by the analysis of the benefits and harms as well as patients' values and preferences. A total of 10 recommendations for the diagnosis and treatment of RA were developed. This new guideline covered the classification criteria, disease activity assessment and monitoring, and the role of disease modifying antirheumatic drugs (DMARDs), biologics, small molecule synthetic targeting drugs, and glucocorticoids in the treat-to-target approach of RA. This guideline is intended to serve as a tool for clinicians and patients to implement decision-making strategies and improve the practices of RA management in China.

Keywords: arthritis; diagnosis; guideline; rheumatoid; therapy.

Figure 1

Procedure for the diagnosis and treatment of RA. Note: ACR, American Rheumatology Society; EULAR, European League Against Rheumatism; NSAIDs, nonsteroidal anti-inflammatory drugs; DMARDs, disease-modifying anti-rheumatic drugs; RA, rheumatoid arthritis. ^aPatients with RA need to change lifestyle after diagnosis. ^bShort-term use or non-use of glucocorticoids or NSAIDs depending on patients’ symptoms and condition. ^cEvaluation as to whether treatment has significant effects. “No” indicates the effect is not significant, i.e., no significant improvement in RA disease activity within 3 months or cannot reach treatment target within 6 months. “Yes” indicates the effect is significant, disease activity is improved within 3 months and the treatment target is reached within 6 months. ^dPhysicians and patients jointly make decisions on whether or not to discontinue biological DMARDs or small molecule targeted synthetic DMARDs