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

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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Affiliated Institutions

• Florida State University US
• Brigham and Women's Hospital US
• Harvard University US
• Johns Hopkins Medicine US
• Global Healthy Living Foundation US
• Yale University US
• Howard University US
• VA Portland Health Care System US
• Hospital for Special Surgery US
• University of Alabama at Birmingham US
• University of Toronto CA
• VA Nebraska Western Iowa Health Care System US
• American College of Rheumatology US
• University of Pennsylvania US
• American University of Beirut LB
• Weill Cornell Medicine US
• Weill Cornell Medical College in Qatar QA
• Birmingham VA Medical Center US
• University of Nebraska Medical Center US
• New York Hospital Queens US
• Stanford Medicine US
• NewYork–Presbyterian Hospital US
• Toronto Western Hospital CA
• Duke Medical Center US
• Philadelphia University US
• Albany Medical Center Hospital US
• University of California, San Diego US
• Columbia University US
• Philadelphia VA Medical Center US
• Berkshire Medical Center US
• Center for Rheumatology US
• Mount Sinai Hospital CA
• Johns Hopkins University US
• Cornell University US
• University of Washington US
• University of California, San Francisco US
• Centers for Disease Control and Prevention US
• Seattle University US
• University of Colorado Anschutz Medical Campus US

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