What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines
Clinical Rheumatology · 2023 · Europe
Source and licence
- Authors
- Brooke Conley, Samantha Bunzli, Jonathan Bullen et al.
- Title
- What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines
- Journal
- Clinical Rheumatology, 2023
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC10412487
Licence statement of the original publication
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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
This is a review of another guideline (Rheumatoid arthritis guidelines (EULAR 2022 et al.), EULAR / ACR / NICE 2023). We do not reproduce that guideline's recommendations here – they belong to the original guideline.
Open the original publication →Full text on Europe PMC
Abstract
Abstract: Systematic r eview to evaluate the quality of the clinical practice guidelines (CPG) for rheumatoid arthritis (RA) management and to provide a synthesis of high-quality CPG recommendations, highlighting areas of consistency, and inconsistency. Electronic searches of five databases and four online guideline repositories were performed. RA management CPGs were eligible for inclusion if they were written in English and published between January 2015 and February 2022; focused on adults ≥ 18 years of age; met the criteria of a CPG as defined by the Institute of Medicine; and were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II instrument. RA CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organization of care and did not include interventional management recommendations; and/or included other arthritic conditions. Of 27 CPGs identified, 13 CPGs met eligibility criteria and were included. Non-pharmacological care should include patient education, patient-centered care, shared decision-making, exercise, orthoses, and a multi-disciplinary approach to care. Pharmacological care should include conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), with methotrexate as the first-line choice. If monotherapy conventional synthetic DMARDs fail to achieve a treatment target, this should be followed by combination therapy conventional synthetic DMARDs (leflunomide, sulfasalazine, hydroxychloroquine), biologic DMARDS and targeted synthetic DMARDS. Management should also include monitoring, pre-treatment investigations and vaccinations, and screening for tuberculosis and hepatitis. Surgical care should be recommended if non-surgical care fails. This synthesis offers clear guidance of evidence-based RA care to healthcare providers.
Trial registration: The protocol for this review was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/UB3Y7).
Supplementary Information: The online version contains supplementary material available at 10.1007/s10067-023-06654-0.
Contents of the original publication
The section headings of the original.
- Introduction
- Materials and methods
- Results
- Consensus recommendations
- Recommendations with “Should do” consensus
- Recommendations with “Could do” consensus
- Recommendations with “Do not do” consensus
- Recommendations with no consensus
- Discussion
- Strengths and potential limitations
- Conclusion
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