Updated guidelines from the European League Against Rheumatism (EULAR), based on new evidence and a review of the literature from 2016 to 2018, address recommendations on the use of disease-modifying antirheumatic drugs and glucocorticoids to treat patients with rheumatoid arthritis (RA). Included is guidance on mono- and combination therapies, treatment strategies, and tapering treatment.
Since the European League Against Rheumatism’s (EULAR) initial recommendations in 2010 for how to manage rheumatoid arthritis (RA) with disease-modifying antirheumatic drugs (DMARDs), progress in the field necessitated 2 updates in 2013 and 2016. A third update was just released in the Annals of Rheumatic Diseases.
With clinical remission the main goal of RA treatment, using DMARDs enables symptom relief; improves physical function, quality of life, and social/work capacity; and inhibits structural damage to cartilage and bone.
This most recent update comprises 5 principles and 12 recommendations on the use of DMARDs—conventional synthetic (cs; methotrexate, leflunomide, sulfasalazine), biological (b; tumour necrosis factor [TNF] inhibitors [adalimumab, certolizumab pegol, etanercept, golimumab, infliximab], abatacept, rituximab, tocilizumab, sarilumab), biosimilar, and targeted synthetic (ts; Janus kinase inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib)—and glucocorticoids to treat patients with RA. Included is guidance on mono- and combination therapies, treatment strategies, and tapering treatment. Altogether, this update considers patient benefits, safety, preferences, and costs related to RA treatment.
The 5 principles build on the previous updates, but they are not based on “specific scientific evidence.” Instead, they are overarching and address treating patients with RA:
The 12 recommendations also incorporate information from the previous updates. However, unlike the principles, they should be followed in this order:
These updated guidelines come on the heels of several new drug approvals in Europe after the 2016 update, and several of the principles and recommendations remain unchanged. However, the authors expect them to be revised again, and soon, so that patients can continue to receive optimal treatment from their treating rheumatologists and other stakeholders remain updated on progress in the field.
“We have reached a steady state of the evidence base for patients with established RA, although still some needs remain unmet, including the need to cure the disease. With the current rate of evidence development, we expect an update of the recommendations to be necessary in about 3-4 years,” they concluded.
Smolen JS, Landewé, RB, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update [published online January 22, 2020]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2019-216655.