scholarly journals 2018 Chinese guidelines for the diagnosis and treatment of rheumatoid arthritis

2021 ◽  
Vol 2 (1) ◽  
pp. 1-14
Author(s):  
Xinping Tian ◽  
Qian Wang ◽  
Mengtao Li ◽  
Yan Zhao ◽  
Zhiyi Zhang ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Treatment Guidelines ◽  
Guideline Development ◽  
Diagnosis And Treatment ◽  
Treat To Target ◽  
Assessment Development ◽  
Activity Assessment ◽  
Assessment And Monitoring

Abstract A multidisciplinary guideline development group was established to formulate this evidence-based diagnosis and treatment guidelines for rheumatoid arthritis (RA) in China. The grading of recommendations, assessment, development, and evaluation (GRADE) system was used to rate the quality of the evidence and the strength of recommendations, which were derived from research articles and guided by the analysis of the benefits and harms as well as patients’ values and preferences. A total of 10 recommendations for the diagnosis and treatment of RA were developed. This new guideline covered the classification criteria, disease activity assessment and monitoring, and the role of disease modifying antirheumatic drugs (DMARDs), biologics, small molecule synthetic targeting drugs, and glucocorticoids in the treat-to-target approach of RA. This guideline is intended to serve as a tool for clinicians and patients to implement decision-making strategies and improve the practices of RA management in China.

scholarly journals The Reproducibility of Patient Self-reported Joint Counts in Rheumatoid Arthritis: A Closer Look at the Results of a Review

2021 ◽  
pp. jrheum.210822
Author(s):  
Salima Francis Elisabeth van Weely
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Systematic Evaluation ◽  
Treat To Target ◽  
Disease Remission ◽  
Remote Care

In the management of rheumatoid arthritis (RA), the systematic evaluation of disease activity is of paramount importance. It is the cornerstone of the "treat-to-target" approach, aiming at disease remission and optimization of quality of life.1 In times of increasing delivery of remote care, accelerated due to the coronavirus disease 2019 (COVID-19) pandemic, the role of patients in the monitoring of disease activity becomes more topical.

scholarly journals AB0221 CURRENT IMPLEMENTATION OF TREAT-TO-TARGET APPROACH IN RHEUMATOID ARTHRITIS TREATMENT: THE PERSPECTIVE OF CHINESE RHEUMATOLOGISTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1136.2-1137
Author(s):  
J. L. Zhao ◽  
X. Liu ◽  
L. Zhan ◽  
H. Tang ◽  
J. Li ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Duration ◽  
Goal Achievement ◽  
Diagnosis And Treatment ◽  
Treat To Target ◽  
Full Time ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Current Implementation ◽  
Advanced Therapy

Background:Treat-to-target (T2T) approach is recommended as a standard management strategy in rheumatoid arthritis (RA) treatment by Chinese guideline for diagnosis and treatment of RA[1]. However, there is little known about its current implementation in China.Objectives:This study aimed to evaluate the implementation and achievement of T2T approach and explore their associated factors in Chinese RA cohort.Methods:A comprehensive cross-sectional survey of rheumatologists and their RA patients was conducted in China. Data were collected during May-Aug 2019 via physician-completed patient record forms. 60 rheumatologists provided data on demographic, clinical characteristics, treatments, and T2T approach implementation for 600 RA patients. Two logistic regressions were used to evaluate factors associated with T2T approach implementation and T2T goal achievement, respectively. Patients with missing data were not included in the models.Results:600 patients were included in this study (48.8±11.7 years, 70.3% female). 39.0% (N=234) of 600 patients were being treated with T2T approach, and 64.9% (N=366) of 564 patients had achieved T2T goal. Patients with longer disease duration (>2 years diagnosis) (odds ratio (OR) [95%CI]=1.61 [1.05, 2.49], vs. diagnosis ≤2 years), higher pain score (OR [95%CI]=1.26 [1.04, 1.51]), or receiving advanced therapy (OR [95%CI]=6.91 [3.64, 13.13]) were more likely to use T2T. Patients with BMI >23.9kg/m2 (OR [95%CI]=2.83 [1.59, 5.04], vs. BMI≤23.9kg/m2), or who worked full-time (OR [95%CI]=2.12 [1.26, 3.57]) were more likely to achieve T2T goal, while patients with more pain (OR [95%CI]=0.77 [0.64, 0.92]) were less likely to achieve T2T goal.Conclusion:Low implementation of T2T approach is observed in Chinese RA treatment. Longer disease duration, more pain, and receiving advanced therapy are associated with higher probability of T2T use, while higher BMI, full-time work and less pain are associated with higher probability of T2T goal achievement. Standard diagnosis and treatment according to guidelines may improve T2T approach implementation.References:[1]Association, C.R., 2018 Chinese guideline for the diagnosis and treatment of rheumatoid arthritis. Zhonghua nei ke za zhi, 2018. 57(4): p. 242.Disclosure of Interests:Jiu-liang Zhao: None declared, Xin Liu Employee of: Eli Lilly and Company, Lujing Zhan Employee of: Eli Lilly and Company, Hongyu Tang Employee of: Eli Lilly and Company (Intern), Jinnan Li Employee of: Eli Lilly and Company, Mengru Liu Employee of: Eli Lilly and Company, Elizabeth Holdsworth Consultant of: Eli Lilly and Company, Employee of: Adelphi Real World, Yan Zhao: None declared

Disease activity assessment in rheumatoid arthritis

2020 ◽  
pp. 161-168
Author(s):  
Josef Smolen
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Joint Pain ◽  
Joint Stiffness ◽  
Treat To Target ◽  
Therapeutic Decision ◽  
Activity Assessment ◽  
Disease Modifying ◽  
Therapeutic Decision Making ◽  
Disease Activity Assessment

The major clinical hallmarks of rheumatoid arthritis (RA) are articular swelling, joint pain, and morning joint stiffness. Disease activity assessment is pivotal when following patients with RA throughout the course of their disease, and especially when assessing improvement or deterioration upon institution of the necessary therapies. To prevent an adverse outcome, it is essential to diagnose the disease early and to start treatment with disease-modifying antirheumatic drugs (DMARDs) immediately after diagnosis. Adhering to the treat-to-target approach, which is a central strategy irrespective of the type of treatment available and the therapy applied, requires consistency in using validated composite measures of disease activity. Rather than a mere matter of using specific therapies, it is also a matter of using tools for disease activity assessment to guide therapeutic decision-making. This enables offering and achieving the best possible outcomes for RA patients.

scholarly journals Nurse-led care versus physician-led care in the management of rheumatoid arthritis and psoriatic arthritis (StaerkeR): study protocol for a multi-center randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Anna Mai ◽  
Jürgen Braun ◽  
Jens-Peter Reese ◽  
Benjamin Westerhoff ◽  
Ulrike Trampisch ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Patient Care ◽  
Functional Capacity ◽  
Standard Care ◽  
Controlled Trial ◽  
Treat To Target ◽  
Lower Saxony

Abstract Background In Germany, the care of patients with inflammatory arthritis could be improved. Although specialized rheumatology nurses could take over substantial aspects of patient care, this hardly occurs in Germany. Thus, the aim of the study is to examine structured nursing consultation in rheumatology practices. Methods/design In total, 800 patients with a stable course of rheumatoid arthritis or psoriatic arthritis in 20 centers in North Rhine–Westphalia and Lower Saxony will be randomized to either nurse-led care or standard care. Participating nurses will study for a special qualification in rheumatology and trial-specific issues. It is hypothesized that nurse-led care is non-inferior to standard care provided by rheumatologists with regard to a reduction of disease activity (DAS28) while it is hypothesized to be superior regarding changes in health-related quality of life (EQ-5D-5L) after 1 year. Secondary outcomes include functional capacity, patient satisfaction with treatment, and resource consumption. Discussion Since there is insufficient care of rheumatology patients in Germany, the study may be able to suggest improvements. Nurse-led care has the potential to provide more efficient and effective patient care. This includes a more stringent implementation of the treat-to-target concept, which may lead to a higher percentage of patients reaching their treatment targets, thereby improving patient-related outcomes, such as quality of life, functional capacity, and participation. Additionally, nurse-led care may be highly cost-effective. Finally, this project may form the basis for a sustainable implementation of nurse-led care in standard rheumatology care in Germany. Trial registration German Clinical Trials Register, DRKS00015526. Registered on 11 January 2019.

scholarly journals The Role of Estrogens in Rheumatoid Arthritis Physiopathology

2020 ◽  
Author(s):  
Maria Fernanda Romo-García ◽  
Martín Zapata-Zuñiga ◽  
José Antonio Enciso-Moreno ◽  
Julio Enrique Castañeda-Delgado
Keyword(s):  
Rheumatoid Arthritis ◽  
Direct Action ◽  
Hormone Replacement ◽  
Joint Disease ◽  
Dependent Manner ◽  
Sexual Hormones ◽  
Dose Dependent ◽  
Estrogen Administration

Rheumatoid arthritis (RA) is a chronic, inflammatory joint disease that can lead to irreversible disability. It affects women in a higher proportion than men (3:1 cases). Several reports suggest a link between female sexual hormones (estrogens) and RA features. It’s been described that biological processes where basal estrogen levels are altered like in menstruation, pregnancy, and menopause modifies RA onset, flare, disease severity, and inflammation. Estrogens have a direct action upon the immune system though ERα and ERβ receptors, which have distinct affinity to estrogen concentrations and modifications and have effects upon RA in a dose and receptor dependent manner. The studies focused on dose dependent response at experimental settings reveal a wide (from 25 pg/L to several μg/L) and even contradictory spectrum of effects in patients and cells. This chapter summarizes the contributions and effects of estrogens in RA physiopathology, clinical features, and discusses the possible contributions of estrogen administration and concentration of hormone replacement therapy (HRT) to improve the quality of life and reduce the symptoms of RA patients based on the knowledge of the biology of these hormones.

Role of depressive symptoms in the health-related quality of life of Venezuelan patients with rheumatoid arthritis. Results from a tertiary care center

2020 ◽  
Vol 29 (8) ◽  
pp. 2129-2136
Author(s):  
Martín A. Rodríguez ◽  
Nardy N. Rivero-Carrera ◽  
Joanny C. Rey-Puente ◽  
Natali Serra-Bonett ◽  
Soham Al Snih
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

scholarly journals The Role of Advanced MRI in the Development of Treat-to-Target Therapeutic Strategies, Patient Stratification and Phenotyping in Rheumatoid Arthritis

2019 ◽  
Author(s):  
Ali Mobasheri ◽  
Mark Hinton ◽  
Olga Kubassova
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Marrow Edema ◽  
Objective Assessment ◽  
Treat To Target ◽  
Resonance Imaging ◽  
Advanced Imaging ◽  
Dce Mri ◽  
Contrast Enhanced ◽  
Magnetic Resonance Imaging Mri

Abstract In this commentary we discuss the potential of advanced imaging, particularly Dynamic Contrast Enhanced (DCE) magnetic resonance imaging (MRI) for the objective assessment of disease progression in rheumatoid arthritis (RA). We emphasise the potential DCE-MRI in advancing the field and exploring new areas of research and development in RA. We believe that different grades of bone marrow edema (BME) and synovitis in RA can be examined and monitored in a more sensitive manner with DCE-MRI. Future treatments for RA will be significantly improved by enhanced imaging of BMEs and synovitis. DCE-MRI will also facilitate enhanced stratification and phenotyping of patients enrolled in clinical trials.

scholarly journals “Treat to Persist”, a deepening of the “Treat to Target”

2020 ◽  
pp. 4-6
Author(s):  
Gustavo Citera ◽  
Eduardo Mysler ◽  
Enrique R. Soriano
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Functional Capacity ◽  
Structural Damage ◽  
Primary Objective ◽  
Treat To Target ◽  
Basic Principles ◽  
Joint Decision

The treatment of rheumatoid arthritis (RA) has evolved considerably in recent years, resulting in a notable improvement in the functional capacity, quality and life expectancy of patients1. This improvement is not only due to the development of more and better medications, but mainly to the internalization by most rheumatologists of the concept of treat to target (T2T) or goal-directed treatment2. The T2T establishes 4 basic principles, which include: A) The treatment of rheumatoid arthritis must be based on a joint decision of the rheumatologist and the patient, B) The primary objective of the treatment of RA is to promote a good quality of life long-term, through the control of symptoms, prevention of structural damage, normalization of functional capacity and social participation of the patient, C) Suppression of inflammation is the main way to achieve these goals, D) Treatment towards a Objectively, evaluating disease activity and adjusting treatment accordingly, improves the outcome of RA patients.

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