{"id":23,"date":"2014-04-25T11:25:53","date_gmt":"2014-04-25T11:25:53","guid":{"rendered":"http:\/\/promotions.bmj.com\/ardsummaries\/?p=23"},"modified":"2014-04-25T11:25:53","modified_gmt":"2014-04-25T11:25:53","slug":"newly-updated-advice-on-using-dmards-for-ra","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/rheumsummaries\/2014\/04\/25\/newly-updated-advice-on-using-dmards-for-ra\/","title":{"rendered":"Newly updated advice on using DMARDs for RA"},"content":{"rendered":"<p><strong>INTRODUCTION<\/strong><\/p>\n<p>Shared decision-making between patients and doctors is a central focus of newly updated recommendations on\u00a0treating rheumatoid arthritis with disease-modifying antirheumatic drugs (DMARDs). The updated recommendations,\u00a0produced by the European League Against Rheumatism (EULAR), also take into account recent<br \/>\nresearch on the benefits and safety of these widely used drugs.<\/p>\n<p><strong>WHAT DO WE KNOW ALREADY?<\/strong><\/p>\n<p>When someone has rheumatoid arthritis (RA), their immune system\u2014which normally fights infection &#8211; mistakenly\u00a0attacks their joints. This makes their joints swollen, stiff, and painful. DMARDs are medicines that help\u00a0stop this happening. They do this by reducing damage to the joints and helping prevent irreversible disability.<br \/>\nThat\u2019s why they are called disease modifying.<\/p>\n<p>DMARDs are the main treatment for RA, and there are many different types. These include:<\/p>\n<p><!--more--><\/p>\n<ul>\n<li>Older, standard types, which are synthesised chemically and are thus called conventional synthetic\u00a0DMARDs. These include methotrexate, sulfasalazine, and leflunomide.<\/li>\n<li>Newer types, which often fall under the category of biological DMARDs. These large molecules are made\u00a0from cells in cultures. They include inhibitors of tumour necrosis factor (TNF) (adalimumab, certolizumab,\u00a0etanercept, golimumab and infliximab), abatacept, tocilizumab, and rituximab.<\/li>\n<\/ul>\n<p>With so many options to consider, deciding on a treatment approach can be a challenge, particularly since\u00a0research doesn\u2019t provide clear answers on which DMARDs work best and are safest. To help with this, the\u00a0EULAR convened a task force of doctors specialising in RA (rheumatologists), other experts, and patient representatives<br \/>\nto review the current research and provide guidance. They have now released their recommendations,\u00a0which are an update of those published in 2010.<\/p>\n<p><strong>WHAT DO THE RECOMMENDATIONS SAY?<\/strong><\/p>\n<p>The updated recommendations emphasise the importance of doctors and patients working together to find the\u00a0best care approach, stressing that treatment must be based on a shared decision between the patient and their\u00a0rheumatologist. Other key principles are:<\/p>\n<ul>\n<li>Rheumatologists are the specialists who should primarily care for people with RA.<\/li>\n<li>Rheumatologists should weigh up the economic, social, and individual costs of the disease and its treatment<br \/>\nwhen considering treatment decisions.<\/li>\n<\/ul>\n<p>The recommendations also go into detail about the best approaches to treating RA with DMARDs. Some\u00a0highlights:<\/p>\n<ul>\n<li>Patients should start taking DMARDs as soon as they are diagnosed with RA.<\/li>\n<li>The aim of the treatment should be remission or low disease activity.<\/li>\n<li>Doctors should monitor patients every one to three months when their RA is active. If a patient has not\u00a0improved enough after three or did not reach an agreed therapeutic target at six months, their treatment\u00a0should be adjusted.<\/li>\n<li>Methotrexate should be the first DMARD doctors and patients consider. If a patient can\u2019t take methotrexate,\u00a0sulfasalazine and leflunomide are other preferred options. These are all conventional synthetic\u00a0DMARDs, and they can be taken alone or combined.<\/li>\n<li>Patients and doctors can consider using corticosteroids called glucocorticoids at low doses, as part of the\u00a0patient\u2019s initial treatment (along with DMARDs). But these drugs should be reduced and stopped as soon as\u00a0possible.<\/li>\n<li>If the first treatment approach doesn\u2019t work well enough, other synthetic DMARDs can be tried. If this falls\u00a0short, biological DMARDs can be considered. However, these drugs can be considered sooner for patients\u00a0who have more active RA with a poorer prognosis.<\/li>\n<li>Biological DMARDs are usually used along with methotrexate.<\/li>\n<li>If one biological DMARD doesn\u2019t help, another can be tried.<\/li>\n<li>If biological DMARDs haven\u2019t helped, a DMARD called tofacitinib can be considered in countries that haveapproved this drug (currently not approved in the EU region due to questions on the benefit-risk ratio).<\/li>\n<li>If a patient is no longer taking corticosteroids and their RA is not active (they are in remission), the dose of\u00a0their biological DMARD may be reduced.<\/li>\n<li>If a patient has been in remission for a long time, their synthetic DMARD dose may be reduced. However,\u00a0this is a decision that should be carefully considered by the patient and their doctor.<\/li>\n<li>When treatment needs to be adjusted, other things need to be taken into account along with a patient\u2019s\u00a0disease activity. These things include any other illnesses the patient may have, the possible side effects of\u00a0current or previous treatment, and the development of joint damage over time.<\/li>\n<\/ul>\n<p><strong>HOW RELIABLE ARE THE RECOMMENDATIONS?<\/strong><\/p>\n<p>These recommendations are based on a thorough review of the current research and knowledge, as well as discussions<br \/>\namong experts and patient representatives. They should provide reliable guidance on the best\u00a0approach to treating RA with DMARDs, based on what current research and experience tell us.<\/p>\n<p><strong>WHAT DOES THIS MEAN FOR ME?<\/strong><\/p>\n<p>If you have RA, these recommendations provide useful insight into what treatments you are likely to be offered\u00a0and when. They also emphasise that you, as a patient, should have a voice in your treatment. If you have any\u00a0questions or concerns, be sure to speak with your rheumatologist.<\/p>\n<p><strong>Disclaimer<\/strong>: This is a summary of a scientific article written by a medical professional (\u201cthe Original Article\u201d). The Summary is written to assist non medically trained readers to understand general points of the Original Article. \u00a0<span style=\"text-decoration: underline\">It should not be relied on in any way whatsoever<\/span>, (which also means the Summary is not medical advice), and is simply supplied to aid a lay understanding of general points of the Original Article. It is supplied \u201cas is\u201d without any warranty. You should note that the Original Article (and Summary) may not be accurate as errors can occur and also may be out of date as medical science is constantly changing. \u00a0<strong>It is very important that readers not rely on the content in the Summary and consult their medical professionals for all aspects of their health care. Do not use this Summary as medical advice even if the Summary is supplied to the reader by a medical professional.<\/strong><br \/>\nPlease view our full <a href=\"http:\/\/www.bmj.com\/company\/legal-information\/\" target=\"_blank\" rel=\"nofollow noopener noreferrer\">Website Terms and Conditions<\/a>.<\/p>\n<p>Date summary prepared:\u00a0April 2014<\/p>\n<p>Summary based on research article published on: 25 October 2013<\/p>\n<p>From:\u00a0Smolen, J. <em>et al<\/em>. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update.\u00a0<em>Ann Rheum Dis<\/em> 2014;73:492-509 <a href=\"http:\/\/ard.bmj.com\/content\/73\/3\/492.full\">doi:10.1136\/annrheumdis-2013-204573<\/a><br \/>\nCopyright \u00a9 2015 BMJ Publishing Group Ltd &amp; European League Against Rheumatism. Medical professionals may print copies for their and their patients and students non commercial use. Other individuals may print a single copy for their personal, non commercial use. For other uses please contact our <a href=\"http:\/\/www.bmj.com\/company\/products-services\/rights-and-licensing\/\" target=\"_blank\" rel=\"nofollow noopener noreferrer\">Rights and Licensing<\/a> Team.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>INTRODUCTION Shared decision-making between patients and doctors is a central focus of newly updated recommendations on\u00a0treating rheumatoid arthritis with disease-modifying antirheumatic drugs (DMARDs). The updated recommendations,\u00a0produced by the European League Against Rheumatism (EULAR), also take into account recent research on the benefits and safety of these widely used drugs. WHAT DO WE KNOW ALREADY? When [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/rheumsummaries\/2014\/04\/25\/newly-updated-advice-on-using-dmards-for-ra\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":384,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16,10,11,6],"tags":[],"class_list":["post-23","post","type-post","status-publish","format-standard","hentry","category-biologics","category-drug-treatment","category-eular-recommendations","category-rheumatoid-arthritis"],"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/posts\/23","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/users\/384"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/comments?post=23"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/posts\/23\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/media?parent=23"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/categories?post=23"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/rheumsummaries\/wp-json\/wp\/v2\/tags?post=23"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}