What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines.

{"article_title":"What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines.","author":"Conley B, Bunzli S, Bullen J, O'Brien P, Persaud J, Gunatillake T, Nikpour M, Grainger R, Barnabe C, Lin I","journal_title":"Clinical rheumatology","issn":"1434-9949","isbn":"","publication_date":"2023 Sep","volume":"42","issue":"9","first_page":"2267","page_count":"","accession_number":"37291382","doi":"10.1007\/s10067-023-06654-0","publisher":"Springer","doctype":"Systematic Review","subjects":"Antirheumatic Agents therapeutic use; Arthritis, Rheumatoid diagnosis; Arthritis, Rheumatoid drug therapy; Adult; Humans; Hydroxychloroquine therapeutic use; Methotrexate therapeutic use; Sulfasalazine therapeutic use; Practice Guidelines as Topic","interest_area":["Rheumatology"," Immunology Allergy & Inflammation"," Orthopedic"],"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 ). \ufffd 2023. Crown.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=37291382&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Conley B, Bunzli S, Bullen J, O'Brien P, Persaud J, Gunatillake T, Nikpour M, Grainger R, Barnabe C, Lin I","Journal_Info":"Publisher: Springer Country of Publication: Germany NLM ID: 8211469 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1434-9949 (Electronic) Linking ISSN: 07703198 NLM ISO Abbreviation: Clin Rheumatol Subsets: MEDLINE","Publication_Type":"Systematic Review; Journal Article; Review","Published_Date":"2023-09-01","Source":"Clinical rheumatology [Clin Rheumatol] 2023 Sep; Vol. 42 (9), pp. 2267-2278. Date of Electronic Publication: 2023 Jun 09.","Languages":"English","Electronic_ISSN":"1434-9949","MeSH_Terms":"Antirheumatic Agents*\/therapeutic use , Arthritis, Rheumatoid*\/diagnosis , Arthritis, Rheumatoid*\/drug therapy, Adult ; Humans ; Hydroxychloroquine\/therapeutic use ; Methotrexate\/therapeutic use ; Sulfasalazine\/therapeutic use ; Practice Guidelines as Topic","Subjects":"Adult, Humans, Hydroxychloroquine therapeutic use, Methotrexate therapeutic use, Sulfasalazine therapeutic use, Practice Guidelines as Topic, Antirheumatic Agents therapeutic use, Arthritis, Rheumatoid diagnosis, Arthritis, Rheumatoid drug therapy","Title_Abbreviations":"Clinical rheumatology","Volume":"42"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"37291382","RelevancyScore":"933","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"933.080810546875"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=37291382&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=37291382&authtype=shib&custid=ns346513&group=main&profile=eds"}