S2e guideline: treatment of rheumatoid arthritis with disease-modifying drugs

被引：0

作者：

Fiehn, C. ^{[1
,6
]}

Holle, J. ^{[1
,7
]}

Iking-Konert, C. ^{[1
,8
]}

Leipe, J. ^{[1
,9
]}

Weseloh, C. ^{[1
]}

Frerix, M. ^{[1
,10
]}

Alten, R. ^{[1
,11
]}

Behrens, F. ^{[1
,12
,13
]}

Baerwald, C. ^{[1
,14
]}

Braun, J. ^{[1
,15
]}

Burkhardt, H. ^{[1
,12
,13
]}

Burmester, G. ^{[1
,16
]}

Detert, J. ^{[1
,16
]}

Gaubitz, M. ^{[1
,17
]}

Gause, A. ^{[1
,18
]}

Gromnica-Ihle, E. ^{[4
]}

Kellner, H. ^{[1
,19
,20
]}

Krause, A. ^{[1
,21
]}

Kuipers, J. ^{[1
,22
]}

Lorenz, H. -M. ^{[1
,23
,24
]}

Mueller-Ladner, U. ^{[1
,10
]}

Nothacker, M. ^{[5
]}

Nuesslein, H. ^{[1
]}

Rubbert-Roth, A. ^{[1
,25
]}

Schneider, M. ^{[1
,26
,27
]}

Schulze-Koops, H. ^{[1
,9
]}

Seitz, S. ^{[2
,3
,28
]}

Sitter, H. ^{[5
]}

Specker, C. ^{[1
,29
]}

Tony, H. -P. ^{[1
,30
]}

Wassenberg, S. ^{[1
,31
]}

Wollenhaupt, J. ^{[1
,32
]}

Krueger, K. ^{[1
,33
]}

机构：

[1] Deutsch Gesell Rheumatol DGRh, Berlin, Germany

[2] Deutsch Gesell Orthopadie & Orthopad Chirurg eV D, Hamburg, Germany

[3] Deutsch Gesell Orthopad Rheumatol DGORh, Hamburg, Germany

[4] Deutsch Rheuma Liga Bundesverband eV, Bonn, Germany

[5] Arbeitsgemeinschaft Wissensch Med Fachgesell eV A, Berlin, Germany

[6] ViDia Kliniken Karlsruhe, Med Ctr Baden Baden, Praxis Rheumatol Tatigkeitsschwerpunkt Klin Immun, Beethovenstr 2, D-76530 Baden Baden, Germany

[7] Rheumazentrum Schleswig Holstein Mitte, Neumunster, Germany

[8] Univ Klin Hamburg Eppendorf UKE, Klin Nephrol & Rheumatol, Med Klin 3, Hamburg, Germany

[9] Ludwig Maximilians Univ Munchen, Med Klin & Poliklin 4, Sekt Rheumatol & Klin Immunol, Munich, Germany

[10] Justus Liebig Univ Giessen, Abt Rheumatol & Klin Immunol, Campus Kerckhoff, Bad Nauheim, Germany

[11] Charite Univ Med Berlin, Schlosspk Klin, Osteol, Abt Innere Med 2,Rheumatol,Klin Immunol, Berlin, Germany

[12] Goethe Univ Frankfurt Main, Univ Klinikum Frankfurt Main, Abt Rheumatol, Frankfurt, Germany

[13] Fraunhofer Inst IME, Translat Med & Pharmakol, Frankfurt, Germany

[14] Univ Klinikum Leipzig, Dept Innere Med Neurol & Dermatol, Sekt Rheumatol, Leipzig, Germany

[15] Rheumazentrum Ruhrgebiet, Herne, Germany

[16] Charite Univ Med Berlin, Med Klin Schwerpunkt Rheumatol & Klin Immunol, Campus Mitte CCM, Berlin, Germany

[17] WWU Munster, Akad Manuelle Therapie, Munster, Germany

[18] Rheumapraxis Bad Bramstedt, Bad Bramstedt, Germany

[19] Schwerpunktpraxis Rheumatol & Gastroenterol, Munich, Germany

[20] Krankenhaus Neuwittelsbach, Abt Rheumatol, Munich, Germany

[21] Immanuel Krankenhaus Berlin, Klin Rheumatol & Klin Immunol, Berlin, Germany

[22] Rotes Kreuz Krankenhaus Bremen gGmbH, Klin Internist Rheumatol, Bremen, Germany

[23] Univ Klinikum Heidelberg, Med Univ Klin Hamatol 5, Onkol, Rheumatol, Heidelberg, Germany

[24] ACURA Rheumazentrum Baden Baden, Baden Baden, Germany

[25] Kantonsspital St Gallen, Klin Rheumatol, St Gallen, Switzerland

[26] Heinrich Heine Univ Dusseldorf, Univ Klinikum Dusseldorf, Poliklin, Funkt Bereich, Dusseldorf, Germany

[27] Heinrich Heine Univ Dusseldorf, Univ Klinikum Dusseldorf, Hiller Forschungszentrum Rheumatol, Dusseldorf, Germany

[28] Marienhospital, Klinikum Hochsauerland, Klin Orthopadie, Arnsberg, Germany

[29] Univ Med Essen, St Josef Krankenhaus Essen Werden, Klin Rheumatol & Klin Immunol, Essen, Germany

[30] Univ Klinikum Wurzburg, Zentrum Innere Med, Abt Rheumatol & Klin Immunol, Wurzburg, Germany

[31] Rheumazentrum Ratingen, Ratingen, Germany

[32] Rheumatologikum Hamburg, Hamburg, Germany

[33] Rheumatol Praxiszentrum, Munich, Germany

来源：

ZEITSCHRIFT FUR RHEUMATOLOGIE | 2018年 / 77卷

关键词：

Rheumatoid arthritis; Guideline; Evidence; Consensus; DMARD; NECROSIS-FACTOR INHIBITORS; HEAD-TO-HEAD; DOUBLE-BLIND; TREATMENT STRATEGIES; REMISSION INDUCTION; CERTOLIZUMAB PEGOL; CLINICAL-OUTCOMES; AMERICAN-COLLEGE; CONTROLLED-TRIAL; JOINT DAMAGE;

D O I：

10.1007/s00393-018-0481-y

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Medication-based strategies to treat rheumatoid arthritis are crucial in terms of outcome. They aim at preventing joint destruction, loss of function and disability by early and consistent inhibition of inflammatory processes. Achieving consensus about evidence-based recommendations for the treatment of rheumatoid arthritis with disease-modifying anti-rheumatic drugs in Germany. Following a systematic literature research, a structured process among expert rheumatologists was used to reach consensus. The results of the consensus process can be summed up in 6 overarching principles and 10 recommendations. There are several new issues compared to the version of 2012, such as differentiated adjustments to the therapeutic regime according to time point and extent of treatment response, the therapeutic goal of achieving remission as assessed by means of the simplified disease activity index (SDAI) as well as the potential use of targeted synthetic DMARDs (JAK inhibitors) and suggestions for a deescalating in case of achieving a sustained remission. Methotrexate still plays the central role at the beginning of the treatment and as a combination partner in the further treatment course. When treatment response to methotrexate is inadequate, either switching to or combining with another conventional synthetic DMARD is an option in the absence of unfavourable prognostic factors. Otherwise biologic or targeted synthetic DMARDs are recommended according to the algorithm. Rules for deescalating treatment with glucocorticoids and-where applicable-DMARDs give support for the management of patients who have reached a sustained remission. The new guidelines set up recommendations for RA treatment in accordance with the treat-to-target principle. Modern disease-modifying drugs, now including also JAK inhibitors, are available in an algorithm.

引用

页码：S35 / S53

页数：19

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