EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs.
EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs.
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DOI：
10.1136/ard.2009.126532
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发表时间：
2010-06
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;Landewé R;Breedveld FC;Dougados M;Emery P;Gaujoux-Viala C;Gorter S;Knevel R;Nam J;Schoels M;Aletaha D;Buch M;Gossec L;Huizinga T;Bijlsma JW;Burmester G;Combe B;Cutolo M;Gabay C;Gomez-Reino J;Kouloumas M;Kvien TK;Martin-Mola E;McInnes I;Pavelka K;van Riel P;Scholte M;Scott DL;Sokka T;Valesini G;van Vollenhoven R;Winthrop KL;Wong J;Zink A;van der Heijde D
风湿病学家对类风湿性关节炎（RA）的治疗可能各不相同，目前尚无关于RA治疗的明确和一致的国际建议。在本文中，建议治疗类风湿关节炎的合成和生物疾病修饰抗风湿药物（DMARDs）和糖皮质激素（GC），也占战略算法和处理经济方面，进行了说明。这些建议是基于对合成DMARD、生物DMARD、GC、治疗策略和经济问题进行的5项系统性文献综述（SLR）的证据。在类似德尔菲的过程中，对SLR得出的证据进行了讨论，并将其总结为专家意见。证据水平，强度的建议和协议的水平。制定了15项建议，涵盖了从一般方面（如缓解/低疾病活动性作为治疗目标）到甲氨蝶呤单药治疗（有或无GC）与合成DMARD联合用药的偏好，以及主要在合成DMARD和肿瘤坏死因子抑制剂治疗失败的患者中使用生物制剂的领域。另外还检查了治疗的成本效益。这些建议旨在告知风湿病学家，患者和其他利益相关者关于欧洲对DMARD和GC管理RA的共识以及基于证据和专家意见达到RA最佳结局的策略。
Treatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-à-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion.
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影响因子：
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作者：
Aletaha, Daniel;Funovits, Julia;Smolen, Josef S.
通讯作者：
Smolen, Josef S.
影响因子：
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作者：
Cohen, Stanley B.;Emery, Paul;Totoritis, Mark C.
通讯作者：
Totoritis, Mark C.
影响因子：
158.5
作者：
Edwards, JCW;Szczepanski, L;Shaw, T
通讯作者：
Shaw, T
DOI：
10.1002/art.24123
发表时间：
2008-10-15
期刊：
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH
影响因子：
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作者：
Aletaha, D.;Landewe, R.;Felson, D.
通讯作者：
Felson, D.
影响因子：
--
作者：
Cohen, S;Hurd, E;McCabe, D
通讯作者：
McCabe, D