FRI0074 UPDATE FOR THE CLINICAL PRACTICE: INTEGRATED, EVIDENCE-BASED APPROACH FOR THE MANAGEMENT OF RHEUMATOID ARTHRITIS
Authors: Mohammed Hassan Abu-Zaid, Yasser El Miedany, Mohammed A Mortada, Waleed Hassan, Mervat Eissa, Yossra Atef, Samah Ismail Nasef, Hala Lotfy, Yomna Farag, Ghada El Deriny, Nadia El Aroussy, Maha El Gaafary, Dalia Mekkawy
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The management of rheumatoid arthritis has evolved in the last few years with greater emphasis on a treat-to-target strategy rather than specific drug regimens.Technologies such as ultrasound have been increasingly used for diagnosis and monitoring of synovitis where it is unclear from clinical examination.These aspects of management were investigated by the Guideline Committee, and recommendations have been updated using new evidence [1, 2]. <h3>Objectives</h3> To develop an updated evidence-based, interdisciplinary recommendations for the management of rheumatoid arthritis (RA). <h3>Methods</h3> The task force comprised rheumatologists, epidemiologists, health economists, and patients. A systematic literature analysis was conducted using the Cochrane Database of Systematic Reviews and MEDLINE. Data regarding the drugs prices and product information were collected to evaluate drug cost and safety. Evidence and recommendations were graded, and an algorithm for treatment and final statements were discussed in a consensus meeting (Nominal Group Technique). Recommendations were developed using a Delphi method by a multidisciplinary panel including patients. <h3>Results</h3> Consensus was reached on recommendations, including a standardized treatment strategy according to the RA severity, activity and prognostic factors in the individual patient. In this updated interdisciplinary guideline for RA the treat to target strategy was considered the cornerstone in these recommendations (figure 1). RA patients should reach clinical, ultrasonographic and functional remission. Treatment decisions should incorporate the disease activity status, structural damage progression (radiologic/sonographic), comorbidities, quality of life and patient motivation. Physiatrist, psychologist and ocupational therapist should be included in interdiscibilnary treatment team for RA. <h3>Conclusion</h3> The treatment strategy included a total of twenty-one evidence based interdisciplinary recommendations for management of RA (figure 1), and is accompanied by a more in-depth discussion of key management principles. These recommendations provide a step-wise approach to treatment, to enable practitioners to develop and support the most effective method of achieving and maintaining remission in RA patients. These recommendations are not to remove the physician's autonomy, and physicians must select the most appropriate therapeutic option, taking into consideration the patient's preferences. <h3>References</h3> [1] Qiang Guo, et al. Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone Res 2018; 6: 15-21. [2] Smolen JS, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017; 76(6):960-977. <h3>Disclosure of Interests</h3> None declared