Update of French society for rheumatology recommendations for managing rheumatoid arthritis
Update of French society for rheumatology recommendations for managing rheumatoid arthritis
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DOI：
10.1016/j.jbspin.2018.10.002
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发表时间：
2019-03-01
期刊：
影响因子：
4.2
通讯作者：
Combe, Bernard
中科院分区：
文献类型：
--
作者：
Daien, Claire;Hua, Charlotte;Combe, Bernard
2014年法国风湿病学会(Societe Francaise de Rheumatologie，SFR)关于类风湿性关节炎(RA)治疗的建议已由一个由12名风湿病专家、2名患者自助小组代表和1名职业治疗师组成的特别工作组更新。工作队使用的材料包括欧盟法律援助法最近的建议、系统的文献审查和专家意见。制定了四项一般性原则和15项建议。一般原则强调风湿病专家和患者共同决策的必要性，以及包括药理学和非药理学治疗在内的全球管理计划的必要性。这些建议涉及RA的诊断战略、治疗目标、管理组织、基于治疗线和预后因素的药物选择、缓解管理以及全球患者管理。修改疾病的抗风湿药物(DMARD)治疗应尽早开始。应定期确定有效的综合评分，以评估疾病活动--根据严格的疾病控制概念--以实现治疗目标，即缓解。甲氨蝶呤是推荐的一线DMARD。当甲氨蝶呤耐受性差或疗效不佳时，应优化治疗方案。在等待常规合成DMARDS生效的同时，可以使用糖皮质激素治疗，短期内保持较低的累积剂量。当没有接受糖皮质激素治疗的患者获得持续缓解而没有结构进展时，应考虑根据严格的疾病控制原则进行靶向治疗降级。应定期筛查患者的合并症及其危险因素，并对其进行评估和治疗。(C)2018年，由Elsevier Masson SAS代表法国兴业银行出版。
The 2014 French Society for Rheumatology (Societe Francaise de Rheumatologie, SFR) recommendations about the management of rheumatoid arthritis (RA) have been updated by a task force composed of 12 expert rheumatologists, 2 patient self-help group representatives, and an occupational therapist. The material used by the task force included recent EULAR recommendations, a systematic literature review, and expert opinion. Four general principles and 15 recommendations were developed. The general principles emphasize the need for shared decision-making between the rheumatologist and the patient and for a global management program including both pharmacological and non-pharmacological treatments. The recommendations deal with the diagnostic strategy for RA, treatment targets, management organization, drug selection based on the treatment line and prognostic factors, management of remissions, and global patient management. Disease-modifying anti-rheumatic drug (DMARD) therapy should be started as early as possible. Validated composite scores should be determined at regular intervals to assess disease activity - according to the tight disease control concept - to achieve the treatment target, i.e., a remission. Methotrexate is the recommended first-line DMARD. The treatment should be optimized when methotrexate is poorly tolerated or inadequately effective. While waiting for conventional synthetic DMARDs to take effect, glucocorticoid therapy can be used, for a brief period to keep the cumulative dose low. When a sustained remission without structural progression is achieved in a patient who is not taking glucocorticoid therapy, targeted therapy de-escalation according to tight disease control principles should be considered. Patients should be periodically screened for comorbidities and their risk factors, which should be evaluated and treated. (C) 2018 Published by Elsevier Masson SAS on behalf of Societe francaise de rhumatologie.