Article

EULAR recommendations for the management of early arthritis: Report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

Leiden University, Leyden, South Holland, Netherlands
Annals of the Rheumatic Diseases (Impact Factor: 9.27). 02/2007; 66(1):34-45. DOI: 10.1136/ard.2005.044354
Source: PubMed

ABSTRACT To formulate EULAR recommendations for the management of early arthritis.
In accordance with EULAR's "standardised operating procedures", the task force pursued an evidence based approach and an approach based on expert opinion. A steering group comprised of 14 rheumatologists representing 10 European countries. The group defined the focus of the process, the target population, and formulated an operational definition of "management". Each participant was invited to propose issues of interest regarding the management of early arthritis or early rheumatoid arthritis. Fifteen issues for further research were selected by use of a modified Delphi technique. A systematic literature search was carried out. Evidence was categorised according to usual guidelines. A set of draft recommendations was proposed on the basis of the research questions and the results of the literature search.. The strength of the recommendations was based on the category of evidence and expert opinion.
15 research questions, covering the entire spectrum of "management of early arthritis", were formulated for further research; and 284 studies were identified and evaluated. Twelve recommendations for the management of early arthritis were selected and presented with short sentences. The selected statements included recognition of arthritis, referral, diagnosis, prognosis, classification, and treatment of early arthritis (information, education, non-pharmacological interventions, pharmacological treatments, and monitoring of the disease process). On the basis of expert opinion, 11 items were identified as being important for future research.
12 key recommendations for the management of early arthritis or early rheumatoid arthritis were developed, based on evidence in the literature and expert consensus.

Download full-text

Full-text

Available from: Robert Landewé, Jul 19, 2015
0 Followers
 · 
110 Views
  • Source
    • "Pharmacological and non-pharmacological therapies in hip osteoarthritis NA NA Zhang W et al, 2005 (22) Biological and non-biological drug therapies in ankylosing spondylitis NA NA Zochling J et al, 2006 (23) Systemic glucocorticoid therapy in rheumatic diseases NA NA Hoes JN et al, 2007 (24) Drug therapies in hand osteoarthritis NA NA Zhang W et al, 2007 (25) Non-biological drug therapies in early rheumatoid arthritis NA NA Combe B et al, 2007 (26) Biological and non-biological therapies in Behçet disease NA NA Hatemi G et al, 2008 (27) Pharmacological and non-pharmacological therapies in fibromyalgia + + Carville SF et al, 2008 (28) Drug therapies in lupus NA NA Bertsias G et al, 2008 (29) Diagnosis of hand osteoarthritis NA NA Zhang W et al, 2009 (30) Biological and non-biological therapies in ankylosing spondylitis NA NA Kiltz U et al, 2009 (31) Biological and non-biological therapies in rheumatoid arthritis + + Smolen JS et al, 2010 (32) Cardiovascular and anti-inflammatory drug therapies in rheumatic diseases NA NA Peters MJ et al, 2010 (33) Biological and non-biological therapies in neuropsychiatric lupus NA NA Bertsias GK et al, 2010 (34) Vaccinations in pediatric patients with rheumatic diseases NA NA Heijstek MW et al, 2011 (35) Vaccinations in adults with rheumatic diseases NA NA van Assen S et al, 2011 (36) Biological and non-biological drug therapies in axial spondyloarthritis NA NA van der Heijde D et al, 2011 (37) Drug therapies in calcium pyrophosphate deposition NA NA Zhang W et al, 2011 (38) Biological and non-biological therapies in ankylosing spondylitis NA NA Braun J et al, 2011 (39) Drug therapies in gout and hyperuricemia + + Hamburger M et al, 2011 (40) Biological and non-biological drug therapies in lupus nephritis NA NA Bertsias GK et al, 2012 (41) Biological and non-biological drug therapies in psoriatic arthritis + + Gossec L et al, 2012 (42) Non-pharmacological management of hip and knee osteoarthritis + NA Fernandes L et al 2013 (43) Diagnostic imaging of joints in the management of rheumatoid arthritis + + Colebatch AN et al, 2013 (44) Glucocorticoid therapy in rheumatic diseases + NA Duru N et al, 2013 (45) Drug therapies in gout and hyperuricemia + + Sivera F et al, 2013 (46) Biological and non-biological therapies in rheumatoid arthritis + + Smolen JS et al, 2013 (47) "
    [Show abstract] [Hide abstract]
    ABSTRACT: This article overviews evidence on common instances of conflict of interest (COI) in research publications from general and specialized fields of biomedicine. Financial COIs are viewed as the most powerful source of bias, which may even distort citation outcomes of sponsored publications. The urge to boost journal citation indicators by stakeholders of science communication is viewed as a new secondary interest, which may compromize the interaction between authors, peer reviewers and editors. Comprehensive policies on disclosure of financial and non-financial COIs in scholarly journals are presented as proxies of their indexing in evidence-based databases, and examples of successful medical journals are discussed in detail. Reports on clinical trials, systematic reviews, meta-analyses and clinical practice guidelines may be unduly influenced by author-pharmaceutical industry relations, but these publications do not always contain explicit disclosures to allow the readers to judge the reliability of the published conclusions and practice-changing recommendations. The article emphasizes the importance of adhering to the guidance on COI from learned associations such as the International Committee of Medical Journal Editors (ICMJE). It also considers joint efforts of authors, peer reviewers and editors as a foundation for appropriately defining and disclosing potential COIs.
    Croatian Medical Journal 12/2013; 54(6):600-8. DOI:10.3325/cmj.2013.54.600 · 1.37 Impact Factor
  • Source
    • "Indeed, some investigators have identified a therapeutic 'window of opportunity', corresponding to approximately 3 months after symptom onset, during which phase aggressive treatment of RA is more likely to succeed compared with the same treatment instituted later in the course of disease [9] [10] [11]. According to the 2007 European League Against Rheumatism (EULAR) guidelines for the management of early arthritis, patients with arthritis of more than one joint should be referred early to a rheumatologist, ideally within 6 weeks after symptom onset [12]. However, there is evidence that in routine practice times to referral (and, consequently, to appropriate treatment initiation) are often suboptimal. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In primary care and internal medicine settings clinicians are often reluctant to take advantage of the resources that ultrasonography (US) offers as a diagnostic tool in the initial management of patients with inflammatory arthritis, despite the recognised importance of an accurate and timely diagnosis of rheumatoid arthritis (RA) and of early referral to ensure optimal patient management. Both grey-scale (GS) and power Doppler (PD) imaging have been extensively used in early detection of synovitis and bone erosions in patients with inflammatory arthritides. We reviewed the main data on the clinical use of US in the initial management of patients with inflammatory arthritis, focusing on RA diagnosis in patients with undifferentiated arthritis, prediction of disease severity, differential diagnoses and assessment of synovitis in children with juvenile idiopathic arthritis (JIA). The role of US in assessing treatment response and monitoring disease activity in clinical remission was also briefly evaluated. The reliability of US as a diagnostic tool in rheumatological diseases has greatly advanced in the last years and the use of this imaging technique, in association with conventional assessments such as physical examination and serological tests, should be considered more often also in primary care settings.
    European Journal of Internal Medicine 09/2013; 25(2). DOI:10.1016/j.ejim.2013.08.700 · 2.30 Impact Factor
  • Source
    • "The concept of remission has been referred to in several sets of recommendations published during the past few years. The EULAR recommendations for the management of early arthritis published in 2007 include a statement that the main goal of treatment with DMARDs is to achieve 'remission', without further guidance on how remission should be defined [90]. In 2010, an international task force published a set of 10 recommendations to achieve optimal therapeutic outcomes, as referred to above, providing guidance on how to 'treat to target' [88]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: With recent improvements in the treatment of rheumatoid arthritis (RA), remission has become an achievable goal for a large proportion of RA patients, and remission is now a defined target in current RA guidelines. However, studies have shown that progression of radiographic joint damage may occur in clinical remission, regardless of the choice of remission definition. Sub-clinical inflammation detected by modern imaging techniques such as ultrasonography and magnetic resonance imaging is present in the majority of patients in clinical remission, and is associated with progressive joint damage and disease activity flare in these patients. This chapter aims to assess the importance of imaging findings in RA patients in clinical remission and to discuss the possible role of modern imaging in future remission criteria.
    Best practice & research. Clinical rheumatology 12/2012; 26(6):767-85. DOI:10.1016/j.berh.2012.10.004 · 3.06 Impact Factor
Show more