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2018 update of the APLAR recommendations for treatment of rheumatoid arthritis.
Int J Rheum Dis. 2019 Mar; 22(3):357-375.IJ

Abstract

AIM

To update recommendations based on current best evidence concerning the treatment of rheumatoid arthritis (RA), focusing particularly on the role of targeted therapies, to inform clinicians on new developments that will impact their current practice.

MATERIALS AND METHODS

A search of relevant literature from 2014 to 2016 concerning targeted therapies in RA was conducted. The RA Update Working Group evaluated the evidence and proposed updated recommendations using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, to describe the quality of evidence and strength of recommendations. Recommendations were finalized through consensus using the Delphi technique.

RESULTS

This update provides 16 RA treatment recommendations based on current best evidence and expert clinical opinion. Recommendations 1-3 deal with the use of conventional synthetic disease-modifying antirheumatic drugs. The next three recommendations (4-6) cover the need for screening and management of infections and comorbid conditions prior to starting targeted therapy, while the following seven recommendations focus on use of these agents. We address choice of targeted therapy, switch, tapering and discontinuation. The last three recommendations elaborate on targeted therapy for RA in special situations such as pregnancy, cancer, and major surgery.

CONCLUSION

Rheumatoid arthritis remains a significant health problem in the Asia-Pacific region. Patients with RA can benefit from the availability of effective targeted therapies, and these updated recommendations provide clinicians with guidance on their use.

Authors+Show Affiliations

Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore.Department of Pediatrics, University of the Philippines Manila, Manila, Philippines. Department of Clinical Epidemiology, University of the Philippines Manila, Manila, Philippines.Department of Medicine, University of Otago Wellington, Wellington, New Zealand.Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan.Jaipur Arthritis Centre, Jaipur, India.Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.Immuno-Rheumatology Center, St Luke's International Hospital, St Luke's International University, Tokyo, Japan.Department of Rheumatology, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, India.Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore.Department of Rheumatology and Immunology, Beijing University People's Hospital, Beijing, China.Rheumatology, Allergy and Immunology Center, St. Luke's Medical Center, Quezon City, Philippines.Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.Department of Rheumatology, Allergy, Immunology, Chang Gung Memorial Hospital, Taipei, Taiwan.Department of Rheumatology and Immunology, Beijing University People's Hospital, Beijing, China.Department of Medicine, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore. Duke-NUS Medical School, Singapore, Singapore.Department of Internal Medicine, Faculty of Medicine, Brawijaya University, Malang, Indonesia.Sari Asih Ciputat Hospital, South Tangerang, Indonesia.Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Malaysia.

Pub Type(s)

Consensus Development Conference
Journal Article
Practice Guideline

Language

eng

PubMed ID

30809944

Citation

Lau, Chak Sing, et al. "2018 Update of the APLAR Recommendations for Treatment of Rheumatoid Arthritis." International Journal of Rheumatic Diseases, vol. 22, no. 3, 2019, pp. 357-375.
Lau CS, Chia F, Dans L, et al. 2018 update of the APLAR recommendations for treatment of rheumatoid arthritis. Int J Rheum Dis. 2019;22(3):357-375.
Lau, C. S., Chia, F., Dans, L., Harrison, A., Hsieh, T. Y., Jain, R., Jung, S. M., Kishimoto, M., Kumar, A., Leong, K. P., Li, Z., Lichauco, J. J., Louthrenoo, W., Luo, S. F., Mu, R., Nash, P., Ng, C. T., Suryana, B., Wijaya, L. K., & Yeap, S. S. (2019). 2018 update of the APLAR recommendations for treatment of rheumatoid arthritis. International Journal of Rheumatic Diseases, 22(3), 357-375. https://doi.org/10.1111/1756-185X.13513
Lau CS, et al. 2018 Update of the APLAR Recommendations for Treatment of Rheumatoid Arthritis. Int J Rheum Dis. 2019;22(3):357-375. PubMed PMID: 30809944.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 2018 update of the APLAR recommendations for treatment of rheumatoid arthritis. AU - Lau,Chak Sing, AU - Chia,Faith, AU - Dans,Leonila, AU - Harrison,Andrew, AU - Hsieh,Tsu Yi, AU - Jain,Rahul, AU - Jung,Seung Min, AU - Kishimoto,Mitsumasa, AU - Kumar,Ashok, AU - Leong,Khai Pang, AU - Li,Zhanguo, AU - Lichauco,Juan Javier, AU - Louthrenoo,Worawit, AU - Luo,Shue Fen, AU - Mu,Rong, AU - Nash,Peter, AU - Ng,Chin Teck, AU - Suryana,Bagus, AU - Wijaya,Linda Kurniaty, AU - Yeap,Swan Sim, Y1 - 2019/02/27/ PY - 2019/01/11/received PY - 2019/01/21/accepted PY - 2019/2/28/pubmed PY - 2019/7/30/medline PY - 2019/2/28/entrez KW - DMARDs KW - biological disease-modifying antirheumatic drugs KW - disease-modifying antirheumatic drugs KW - rheumatoid arthritis KW - targeted therapy KW - treatment SP - 357 EP - 375 JF - International journal of rheumatic diseases JO - Int J Rheum Dis VL - 22 IS - 3 N2 - AIM: To update recommendations based on current best evidence concerning the treatment of rheumatoid arthritis (RA), focusing particularly on the role of targeted therapies, to inform clinicians on new developments that will impact their current practice. MATERIALS AND METHODS: A search of relevant literature from 2014 to 2016 concerning targeted therapies in RA was conducted. The RA Update Working Group evaluated the evidence and proposed updated recommendations using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, to describe the quality of evidence and strength of recommendations. Recommendations were finalized through consensus using the Delphi technique. RESULTS: This update provides 16 RA treatment recommendations based on current best evidence and expert clinical opinion. Recommendations 1-3 deal with the use of conventional synthetic disease-modifying antirheumatic drugs. The next three recommendations (4-6) cover the need for screening and management of infections and comorbid conditions prior to starting targeted therapy, while the following seven recommendations focus on use of these agents. We address choice of targeted therapy, switch, tapering and discontinuation. The last three recommendations elaborate on targeted therapy for RA in special situations such as pregnancy, cancer, and major surgery. CONCLUSION: Rheumatoid arthritis remains a significant health problem in the Asia-Pacific region. Patients with RA can benefit from the availability of effective targeted therapies, and these updated recommendations provide clinicians with guidance on their use. SN - 1756-185X UR - https://www.unboundmedicine.com/medline/citation/30809944/2018_update_of_the_APLAR_recommendations_for_treatment_of_rheumatoid_arthritis_ L2 - https://doi.org/10.1111/1756-185X.13513 DB - PRIME DP - Unbound Medicine ER -