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

被引：352

作者：

Fraenkel, Liana ^{[1
,2
]}

Bathon, Joan M. ^{[3
,4
]}

England, Bryant R. ^{[5
,6
]}

St Clair, E. William ^{[7
]}

Arayssi, Thurayya ^{[8
]}

Carandang, Kristine ^{[9
]}

Deane, Kevin D. ^{[10
]}

Genovese, Mark ^{[11
]}

Huston, Kent Kwas ^{[12
]}

Kerr, Gail ^{[13
]}

Kremer, Joel ^{[14
,15
]}

Nakamura, Mary C. ^{[16
]}

Russell, Linda A. ^{[17
]}

Singh, Jasvinder A. ^{[18
,19
]}

Smith, Benjamin J. ^{[20
]}

Sparks, Jeffrey A. ^{[21
,22
]}

Venkatachalam, Shilpa ^{[23
]}

Weinblatt, Michael E. ^{[21
,22
]}

Al-Gibbawi, Mounir ^{[24
]}

Baker, Joshua F. ^{[25
,26
]}

Barbour, Kamil E. ^{[27
]}

Barton, Jennifer L. ^{[28
,29
]}

Cappelli, Laura ^{[30
]}

Chamseddine, Fatimah ^{[24
]}

George, Michael ^{[26
]}

Johnson, Sindhu R. ^{[31
]}

Kahale, Lara ^{[24
]}

Karam, Basil S. ^{[24
]}

Khamis, Assem M. ^{[24
]}

Navarro-Millan, Iris ^{[32
]}

Mirza, Reza ^{[33
]}

Schwab, Pascale ^{[28
,29
]}

Singh, Namrata ^{[34
]}

Turgunbaev, Marat ^{[35
]}

Turner, Amy S. ^{[35
]}

Yaacoub, Sally ^{[24
]}

Akl, Elie A. ^{[24
]}

机构：

[1] Berkshire Med Ctr, Pittsfield, MA USA

[2] Yale Univ, Sch Med, New Haven, CT USA

[3] Columbia Univ, Irving Med Ctr, New York, NY USA

[4] Presbyterian Hosp, New York, NY USA

[5] Univ Nebraska, Med Ctr, Omaha, NE USA

[6] VA Nebraska Western Iowa Hlth Care Syst, Omaha, NE USA

[7] Duke Univ, Med Ctr, Durham, NC USA

[8] Weill Cornell Med Qatar, Doha, Qatar

[9] Univ Calif San Diego, San Diego, CA 92103 USA

[10] Univ Colorado, Aurora, CO USA

[11] Stanford Univ, Med Ctr, Palo Alto, CA 94304 USA

[12] Ctr Rheumat Dis Allergy & Immunol, Kansas City, MO USA

[13] Georgetown & Howard Univ, Vet Affairs Med Ctr, Washington, DC USA

[14] Albany Med Coll, Albany, NY 12208 USA

[15] Ctr Rheumatol, Albany, NY USA

[16] Univ Calif San Francisco, San Francisco, CA 94143 USA

[17] Hosp Special Surg, 535 E 70th St, New York, NY 10021 USA

[18] Univ Alabama Birmingham, Birmingham, AL USA

[19] Birmingham Vet Affairs Med Ctr, Birmingham, AL USA

[20] Florida State Univ, Coll Med, Sch Phys Assistant Practice, Tallahassee, FL 32306 USA

[21] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

[22] Harvard Med Sch, Boston, MA 02115 USA

[23] Global Hlth Living Fdn, Upper Nyack, NY USA

[24] Amer Univ Beirut, Beirut, Lebanon

[25] Corporal Michael J Crescenz VA Med Ctr, Philadelphia, PA USA

[26] Univ Penn, Philadelphia, PA 19104 USA

[27] Ctr Dis Control & Prevent, Atlanta, GA USA

[28] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[29] VA Portland Hlth Care Syst, Portland, OR USA

[30] Johns Hopkins Med, Baltimore, MD USA

[31] Univ Toronto, Toronto Western Hosp, Mt Sinai Hosp, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[32] Weill Cornell Med, New York, NY USA

[33] Univ Toronto, Toronto, ON, Canada

[34] Univ Washington, Seattle, WA 98195 USA

[35] Amer Coll Rheumatol, 60 Execut Pk S,Suite 150, Atlanta, GA 30329 USA

来源：

ARTHRITIS & RHEUMATOLOGY | 2021年 / 73卷 / 07期

关键词：

MODIFYING ANTIRHEUMATIC DRUGS; TRIPLE THERAPY; PLUS METHOTREXATE; BIOLOGIC AGENTS; HEART-FAILURE; RISK-FACTORS; ETANERCEPT; DISEASE; RECOMMENDATIONS; TRIAL;

D O I：

10.1002/art.41752

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1108 / 1123

页数：16

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