2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis
2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis
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DOI：
10.1002/art.41752
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发表时间：
2021-06-08
影响因子：
13.3
通讯作者：
Akl, Elie A.
中科院分区：
文献类型：
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作者：
Fraenkel, Liana;Bathon, Joan M.;Akl, Elie A.
目的制定类风湿关节炎药物治疗的最新指南。方法我们制定了临床相关人群、干预、比较和结局（皮科）问题。在进行了系统的文献综述后，使用建议评估、开发和评价分级（GRADE）方法对证据的确定性进行了评级。由临床医生和患者组成的投票小组就建议的方向（支持或反对）和强度（强烈或有条件）达成了共识。结果该指南涉及疾病修饰抗风湿药物（DMARDs）的治疗，包括常规合成DMARDs，生物DMARDs和靶向合成DMARDs，糖皮质激素的使用，以及某些高危人群（即，患有肝病、心力衰竭、淋巴增生性疾病、既往严重感染和非结核分枝杆菌肺病的患者）。该指南包括44项建议（7强和37条件）。结论本临床实践指南旨在作为一种工具，以支持临床医生和患者的决策。建议不是处方性的，个体治疗决定应该根据患者的价值观、目标、偏好和合并症通过共同的决策过程做出。
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.