Treating rheumatoid arthritis to target

2014 update of the recommendations of an international task force

Josef S. Smolen, Ferdinand C. Breedveld, Gerd R. Burmester, Vivian Bykerk, Maxime Dougados, Paul Emery, Tore K. Kvien, M. Victoria Navarro-Compán, Susan Oliver, Monika Schoels, Marieke Scholte-Voshaar, Tanja Stamm, Michaela Stoffer, Tsutomu Takeuchi, Daniel Aletaha, Jose Louis Andreu, Martin Aringer, Martin Bergman, Neil Betteridge, Hans Bijlsma & 23 others Harald Burkhardt, Mario Cardiel, Bernard Combe, Patrick Durez, Joao Eurico Fonseca, Alan Gibofsky, Juan J. Gomez-Reino, Winfried Graninger, Pekka Hannonen, Boulos Haraoui, Marios Kouloumas, Robert Landewe, Emilio Martin-Mola, Peter Nash, Mikkel Ostergaard, Andrew Östör, Pam Richards, Tuulikki Sokka-Isler, Carter Thorne, Athanasios G. Tzioufas, Ronald van Vollenhoven, Martinus de Wit, Heijde van der

Research output: Contribution to journalArticle

416 Citations (Scopus)

Abstract

Background Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. Objective To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. Methods A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. Results The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (=9/10). Conclusions The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.

Original languageEnglish
JournalBritish Journal of Sports Medicine
DOIs
Publication statusAccepted/In press - 2015 May 12

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Advisory Committees
Rheumatoid Arthritis
Comorbidity
Therapeutics
Expert Testimony
Decision Making
Joints

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Smolen, J. S., Breedveld, F. C., Burmester, G. R., Bykerk, V., Dougados, M., Emery, P., ... van der, H. (Accepted/In press). Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. British Journal of Sports Medicine. https://doi.org/10.1136/annrheumdis-2015-207524

Treating rheumatoid arthritis to target : 2014 update of the recommendations of an international task force. / Smolen, Josef S.; Breedveld, Ferdinand C.; Burmester, Gerd R.; Bykerk, Vivian; Dougados, Maxime; Emery, Paul; Kvien, Tore K.; Navarro-Compán, M. Victoria; Oliver, Susan; Schoels, Monika; Scholte-Voshaar, Marieke; Stamm, Tanja; Stoffer, Michaela; Takeuchi, Tsutomu; Aletaha, Daniel; Andreu, Jose Louis; Aringer, Martin; Bergman, Martin; Betteridge, Neil; Bijlsma, Hans; Burkhardt, Harald; Cardiel, Mario; Combe, Bernard; Durez, Patrick; Fonseca, Joao Eurico; Gibofsky, Alan; Gomez-Reino, Juan J.; Graninger, Winfried; Hannonen, Pekka; Haraoui, Boulos; Kouloumas, Marios; Landewe, Robert; Martin-Mola, Emilio; Nash, Peter; Ostergaard, Mikkel; Östör, Andrew; Richards, Pam; Sokka-Isler, Tuulikki; Thorne, Carter; Tzioufas, Athanasios G.; van Vollenhoven, Ronald; de Wit, Martinus; van der, Heijde.

In: British Journal of Sports Medicine, 12.05.2015.

Research output: Contribution to journalArticle

Smolen, JS, Breedveld, FC, Burmester, GR, Bykerk, V, Dougados, M, Emery, P, Kvien, TK, Navarro-Compán, MV, Oliver, S, Schoels, M, Scholte-Voshaar, M, Stamm, T, Stoffer, M, Takeuchi, T, Aletaha, D, Andreu, JL, Aringer, M, Bergman, M, Betteridge, N, Bijlsma, H, Burkhardt, H, Cardiel, M, Combe, B, Durez, P, Fonseca, JE, Gibofsky, A, Gomez-Reino, JJ, Graninger, W, Hannonen, P, Haraoui, B, Kouloumas, M, Landewe, R, Martin-Mola, E, Nash, P, Ostergaard, M, Östör, A, Richards, P, Sokka-Isler, T, Thorne, C, Tzioufas, AG, van Vollenhoven, R, de Wit, M & van der, H 2015, 'Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force', British Journal of Sports Medicine. https://doi.org/10.1136/annrheumdis-2015-207524
Smolen, Josef S. ; Breedveld, Ferdinand C. ; Burmester, Gerd R. ; Bykerk, Vivian ; Dougados, Maxime ; Emery, Paul ; Kvien, Tore K. ; Navarro-Compán, M. Victoria ; Oliver, Susan ; Schoels, Monika ; Scholte-Voshaar, Marieke ; Stamm, Tanja ; Stoffer, Michaela ; Takeuchi, Tsutomu ; Aletaha, Daniel ; Andreu, Jose Louis ; Aringer, Martin ; Bergman, Martin ; Betteridge, Neil ; Bijlsma, Hans ; Burkhardt, Harald ; Cardiel, Mario ; Combe, Bernard ; Durez, Patrick ; Fonseca, Joao Eurico ; Gibofsky, Alan ; Gomez-Reino, Juan J. ; Graninger, Winfried ; Hannonen, Pekka ; Haraoui, Boulos ; Kouloumas, Marios ; Landewe, Robert ; Martin-Mola, Emilio ; Nash, Peter ; Ostergaard, Mikkel ; Östör, Andrew ; Richards, Pam ; Sokka-Isler, Tuulikki ; Thorne, Carter ; Tzioufas, Athanasios G. ; van Vollenhoven, Ronald ; de Wit, Martinus ; van der, Heijde. / Treating rheumatoid arthritis to target : 2014 update of the recommendations of an international task force. In: British Journal of Sports Medicine. 2015.
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title = "Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force",
abstract = "Background Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. Objective To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. Methods A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. Results The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (=9/10). Conclusions The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.",
author = "Smolen, {Josef S.} and Breedveld, {Ferdinand C.} and Burmester, {Gerd R.} and Vivian Bykerk and Maxime Dougados and Paul Emery and Kvien, {Tore K.} and Navarro-Comp{\'a}n, {M. Victoria} and Susan Oliver and Monika Schoels and Marieke Scholte-Voshaar and Tanja Stamm and Michaela Stoffer and Tsutomu Takeuchi and Daniel Aletaha and Andreu, {Jose Louis} and Martin Aringer and Martin Bergman and Neil Betteridge and Hans Bijlsma and Harald Burkhardt and Mario Cardiel and Bernard Combe and Patrick Durez and Fonseca, {Joao Eurico} and Alan Gibofsky and Gomez-Reino, {Juan J.} and Winfried Graninger and Pekka Hannonen and Boulos Haraoui and Marios Kouloumas and Robert Landewe and Emilio Martin-Mola and Peter Nash and Mikkel Ostergaard and Andrew {\"O}st{\"o}r and Pam Richards and Tuulikki Sokka-Isler and Carter Thorne and Tzioufas, {Athanasios G.} and {van Vollenhoven}, Ronald and {de Wit}, Martinus and {van der}, Heijde",
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month = "5",
day = "12",
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T1 - Treating rheumatoid arthritis to target

T2 - 2014 update of the recommendations of an international task force

AU - Smolen, Josef S.

AU - Breedveld, Ferdinand C.

AU - Burmester, Gerd R.

AU - Bykerk, Vivian

AU - Dougados, Maxime

AU - Emery, Paul

AU - Kvien, Tore K.

AU - Navarro-Compán, M. Victoria

AU - Oliver, Susan

AU - Schoels, Monika

AU - Scholte-Voshaar, Marieke

AU - Stamm, Tanja

AU - Stoffer, Michaela

AU - Takeuchi, Tsutomu

AU - Aletaha, Daniel

AU - Andreu, Jose Louis

AU - Aringer, Martin

AU - Bergman, Martin

AU - Betteridge, Neil

AU - Bijlsma, Hans

AU - Burkhardt, Harald

AU - Cardiel, Mario

AU - Combe, Bernard

AU - Durez, Patrick

AU - Fonseca, Joao Eurico

AU - Gibofsky, Alan

AU - Gomez-Reino, Juan J.

AU - Graninger, Winfried

AU - Hannonen, Pekka

AU - Haraoui, Boulos

AU - Kouloumas, Marios

AU - Landewe, Robert

AU - Martin-Mola, Emilio

AU - Nash, Peter

AU - Ostergaard, Mikkel

AU - Östör, Andrew

AU - Richards, Pam

AU - Sokka-Isler, Tuulikki

AU - Thorne, Carter

AU - Tzioufas, Athanasios G.

AU - van Vollenhoven, Ronald

AU - de Wit, Martinus

AU - van der, Heijde

PY - 2015/5/12

Y1 - 2015/5/12

N2 - Background Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. Objective To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. Methods A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. Results The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (=9/10). Conclusions The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.

AB - Background Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. Objective To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. Methods A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. Results The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (=9/10). Conclusions The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.

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