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. 2023 Sep;42(9):2267-2278.
doi: 10.1007/s10067-023-06654-0. Epub 2023 Jun 9.

What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines

Brooke Conley  1 , Samantha Bunzli  2   3   4 , Jonathan Bullen  5 , Penny O'Brien  6 , Jennifer Persaud  7   8 , Tilini Gunatillake  6 , Mandana Nikpour  9 , Rebecca Grainger  10   11 , Cheryl Barnabe  12 , Ivan Lin  13   14
Affiliations

What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines

Brooke Conley et al. Clin Rheumatol. 2023 Sep.

Abstract

Systematic r eview to evaluate the quality of the clinical practice guidelines (CPG) for rheumatoid arthritis (RA) management and to provide a synthesis of high-quality CPG recommendations, highlighting areas of consistency, and inconsistency. Electronic searches of five databases and four online guideline repositories were performed. RA management CPGs were eligible for inclusion if they were written in English and published between January 2015 and February 2022; focused on adults ≥ 18 years of age; met the criteria of a CPG as defined by the Institute of Medicine; and were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II instrument. RA CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organization of care and did not include interventional management recommendations; and/or included other arthritic conditions. Of 27 CPGs identified, 13 CPGs met eligibility criteria and were included. Non-pharmacological care should include patient education, patient-centered care, shared decision-making, exercise, orthoses, and a multi-disciplinary approach to care. Pharmacological care should include conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), with methotrexate as the first-line choice. If monotherapy conventional synthetic DMARDs fail to achieve a treatment target, this should be followed by combination therapy conventional synthetic DMARDs (leflunomide, sulfasalazine, hydroxychloroquine), biologic DMARDS and targeted synthetic DMARDS. Management should also include monitoring, pre-treatment investigations and vaccinations, and screening for tuberculosis and hepatitis. Surgical care should be recommended if non-surgical care fails. This synthesis offers clear guidance of evidence-based RA care to healthcare providers. TRIAL REGISTRATION: The protocol for this review was registered with Open Science Framework ( https://doi.org/10.17605/OSF.IO/UB3Y7 ).

Keywords: Evidence-based care; Evidence-based medicine; Practice guidelines; Rheumatoid arthritis; Systematic review.

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Conflict of interest statement

Professor Cheryl Barnabe—Past 2 years—speaking fees from Fresenius Kabi, Janssen, Pfizer; advisory board fees from Celltrion Healthcare, Sanofi Genzyme. There are no other competing interests for the remaining authors.

Figures

Fig. 1
Fig. 1
Creating the consensus recommendations
Fig. 2
Fig. 2
PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers, and other sources
Fig. 3
Fig. 3
Treatment pathway
See this image and copyright information in PMC

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