Treating rheumatoid arthritis to target: recommendations of an international task force

Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna,Waehringer Guertel 18-20, Vienna, Austria.
Annals of the rheumatic diseases (Impact Factor: 9.27). 03/2010; 69(4):631-7. DOI: 10.1136/ard.2009.123919
Source: PubMed

ABSTRACT Aiming at therapeutic targets has reduced the risk of organ failure in many diseases such as diabetes or hypertension. Such targets have not been defined for rheumatoid arthritis (RA).
/st> To develop recommendations for achieving optimal therapeutic outcomes in RA.
A task force of rheumatologists and a patient developed a set of recommendations on the basis of evidence derived from a systematic literature review and expert opinion; these were subsequently discussed, amended and voted upon by >60 experts from various regions of the world in a Delphi-like procedure. Levels of evidence, strength of recommendations and levels of agreement were derived.
The treat-to-target activity resulted in 10 recommendations. The treatment aim was defined as remission with low disease activity being an alternative goal in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with appropriate therapeutic adaptation to reach the desired state within 3 to a maximum of 6 months was recommended. Follow-up examinations ought to employ composite measures of disease activity which include joint counts. Additional items provide further details for particular aspects of the disease. Levels of agreement were very high for many of these recommendations (> or =9/10).
The 10 recommendations are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA based on evidence and expert opinion.

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Available from: Johannes W J Bijlsma, Jul 13, 2015
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    • "It goes beyond just information-giving and can be defined as an interactive process between patients and health professionals aimed at supporting and enabling patients to manage their life with arthritis and optimising their health and well being (Zangi 2014). The current European League Against Rheumatism (EULAR) 'treat to target' recommendations and National Institute for Health and Care Excellence (NICE) guidelines for RA, emphasise the importance of patient education and shared decision-making between the patient and the health professional (NICE 2009, Smolen et al. 2010). The NICE guidelines (NICE 2009) also acknowledge the contribution of the clinical nurse specialists (CNS) in coordinating patient care and provision of patient education. "
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    ABSTRACT: Aims and objectivesTo evaluate the usability of the educational needs assessment tool in clinical practice, from a practitioner and patient perspective and to establish whether patients perceive that they are getting an equally good or equally inadequate education service for their needs.Background The educational needs assessment tool was developed to enable patients with Rheumatoid Arthritis to assess their education needs prior to a consultation with a health professional. The educational needs assessment tool has been translated into nine languages and measurement properties have been established, however, its usability in clinical practice has not been studied.DesignA qualitative study embedded into a multicentre RCT in which patients had been randomised into either educational needs assessment tool-focused education (Experimental Group) or usual care (control group).Methods Both groups were seen by a clinical nurse specialist. Sixteen patients and four clinical nurse specialists were recruited from the Rheumatology Outpatient Departments of three Acute Hospitals within the U K. Data were collected by interviews with patients and clinical nurse specialist. Analysis followed the Framework approach.ResultsPatients and clinical nurse specialist found completion of the educational needs assessment tool straightforward, comprehensive and easy to use. Completing the educational needs assessment tool helped patients to focus on what they needed to know from the clinical nurse specialist. Patients in both the control group and the experimental group felt supported and reassured by their clinical nurse specialist and perceived that they received a good and adequate education provision.Conclusion This study provides useful insights into the ability of the educational needs assessment tool to assess the educational needs of patients with rheumatoid arthritis in routine clinical practice.Relevance to clinical practiceThe educational needs assessment tool would be useful as a structured guide for nurses when assessing and meeting individual patient educational needs. This has the potential to improve patient-centred care, involve patients more actively in their care and enhance the long-term effects of patient education provision.
    Journal of Clinical Nursing 11/2014; 24(7-8). DOI:10.1111/jocn.12733 · 1.23 Impact Factor
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    • "Although they both have peculiar features such as the presence of specific autoantibodies, in the case of RA, or involvement of skin and nails, in the case of PsA, they show many similarities. Joint distribution, clinical and radiological manifestations may be so identical -especially early at the beginning of diseasethat differentiation reveals impossibile except if hard-to-gain-biopsy specimens showing distinct vascularization patterns are available [1]. Among all forms of arthritides RA has the worst outcome, so that an early identification and treatment is considered imperative [2]. "
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    ABSTRACT: Inflammatory rheumatic diseases are leading causes of disability and constitute a frequent medical disorder, leading to inability to work, high comorbidity and increased mortality. The gold-standard for diagnosing and differentiating arthritis is based on patient conditions and radiographic findings, as joint erosions or decalcification. However, early signs of arthritis are joint effusion, hypervascularization and synovial hypertrophy. In particular, vascularization has been shown to correlate with arthritis' destructive behavior, more than clinical assessment. Contrast Enhanced Ultrasound (CEUS) examination of the small joints is emerging as a sensitive tool for assessing vascularization and disease activity. The evaluation of perfusion pattern rely on subjective semi-quantitative scales, that are able to capture the macroscopic degree of vascularization, but are unable to detect the subtler differences in kinetics perfusion parameters that might lead to a deeper understanding of disease progression and a better management of patients. We show that after a kinetic analysis of contrast agent appearance, providing the quantitative features characterizing the perfusion pattern of the joint, it is possible to accurately discriminate RA from PSA by building a random forest classifier on the computed features. We compare its accuracy with the assessment performed by expert radiologist blinded of the diagnosis.
    SPIE Medical Imaging 2014, San Diego; 03/2014
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    • "This is particularly important because the therapeutic approach to RA has greatly improved as a result of its earlier diagnosis and treatment [14] [15] and the availability of bio(techno)logical drugs such as anti-TNFí µí»¼ agents [16]. The European League Against Rheumatism (EULAR) recommendations stress the well-timed use of anti-TNF agents in the case of the premature failure of traditional disease modifying antirheumatic drugs (DMARDs) [17]. The Health Assessment Questionnaire (HAQ) is the most widely used index of disability in RA: it is sensitive, effective, reliable, cheap and rapid to administer, reflects the patients' point of view, and correlates well with measures of chronic "
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    ABSTRACT: This study involving 1033 patients with RA confirms the effectiveness of etanercept, adalimumab, and infliximab in reducing RA-related disability even in patients with a history of highly active and longstanding RA. Moreover, we found that the improvement in disability was biphasic, with a marked improvement during the first year of anti-TNF therapy, followed by slower but significant recovery over the subsequent four years.
    BioMed Research International 07/2014; 2014:416892. DOI:10.1155/2014/416892 · 2.71 Impact Factor
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