Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force.
Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force.
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DOI：
10.1136/annrheumdis-2015-207524
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发表时间：
2016-01
影响因子：
27.4
通讯作者：
van der Heijde D
中科院分区：
文献类型：
--
作者：
Smolen JS;Breedveld FC;Burmester GR;Bykerk V;Dougados M;Emery P;Kvien TK;Navarro-Compán MV;Oliver S;Schoels M;Scholte-Voshaar M;Stamm T;Stoffer M;Takeuchi T;Aletaha D;Andreu JL;Aringer M;Bergman M;Betteridge N;Bijlsma H;Burkhardt H;Cardiel M;Combe B;Durez P;Fonseca JE;Gibofsky A;Gomez-Reino JJ;Graninger W;Hannonen P;Haraoui B;Kouloumas M;Landewe R;Martin-Mola E;Nash P;Ostergaard M;Östör A;Richards P;Sokka-Isler T;Thorne C;Tzioufas AG;van Vollenhoven R;de Wit M;van der Heijde D
达到缓解或低疾病活动度的治疗目标可显著改善类风湿关节炎（RA）患者的预后。2010年制定的从治疗到靶向的建议为在常规临床实践中实施实现这一治疗目标的战略方法提供了基础，但这些建议需要根据新的见解重新评估其适当性和实用性。更新基于系统文献综述和专家意见的2010年治疗到目标建议。一个由风湿病学家、患者和一名专科护士组成的工作组评估了SLR结果，并相应地评估了2010年建议中的个别项目，重新制定了许多项目。随后，来自世界各地的40多名专家（包括5名患者）对这些标准进行了讨论、修订和投票。得出了证据水平、建议的强度和一致程度。更新后产生了4项总体原则和10项建议。对以前的建议作了部分调整，专家们认为，按照重要性适当地改变了这些建议的顺序。SLR现在还提供了针对低疾病活动性或缓解的有效性的数据，而不仅仅是早期疾病。合并症的作用，包括它们阻止强化治疗的潜力，比以前更加突出。治疗目标再次被定义为缓解，低疾病活动性是另一个目标，特别是对于长期疾病的患者。建议定期随访（活动性疾病期间每1-3个月），根据治疗适应达到所需状态。随访检查应采用包括关节计数在内的疾病活动度的综合测量方法。其他项目提供了该疾病特定方面的进一步细节，特别是合并症和与患者共同决策。与2010年的建议相比，许多项目的证据水平都有所提高，大多数单项建议的一致性水平非常高（≥9/10）。4项总体原则和10项建议是基于比以前更有力的证据，旨在告知患者、风湿病学家和其他利益相关者关于达到RA最佳结果的策略。
Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1–3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (≥9/10). The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.