scholarly journals Management of antiphospholipid syndrome in adults: The European League Against Rheumatism (EULAR) recommendations

2019 ◽  
Vol 53 (4) ◽  
pp. 144-150
Author(s):  
Mirjana Veselinović ◽  
Aleksandra Tomić-Lučić ◽  
Vladimir Jakovljević ◽  
Ana Aničić
Keyword(s):  
Antiphospholipid Syndrome ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
European League

Vaccination in immunocompromised adults

2013 ◽  
pp. 717-720
Author(s):  
Sander van Assen ◽  
Marc Bijl
Keyword(s):  
Pneumococcal Infection ◽  
Pneumococcal Vaccination ◽  
Underlying Disease ◽  
Inflammatory Rheumatic Diseases ◽  
Live Vaccines ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Immunosuppressed Patients ◽  
Humoral Responses ◽  
European League

This chapter addresses all important questions regarding vaccination of patients with autoimmune inflammatory rheumatic diseases (AIIRD). First, the incidence of vaccine-preventable infections in these patients is discussed. Pulmonary infections, including influenza and pneumococcal infection, occur more often in AIIRD patients; herpes zoster and human papillomavirus are also more frequent. The efficacy of vaccination for all European registered vaccines is discussed. Treatment with disease-modifying anti-rheumatic drugs (DMARDs) and biologicals (in particular TNFα‎‎-blocking agents) do not hamper, or only slightly hamper, the immune responses to most vaccines. Rituximab is an exception, severely reducing humoral responses following influenza and pneumococcal vaccination, at least during the first 6 months after administration. Safety of vaccination is an important issue in patients with autoimmune diseases, since increased disease activity of the underlying disease as a result of vaccination is theoretically possible. The available evidence is summarized, suggesting that vaccination is safe in AIIRD patients. Live vaccines, however, are contraindicated in immunosuppressed patients with AIIRD. Finally, the European League Against Rheumatism (EULAR) recommendations are highlighted, summarizing the ’do’s’ and ’don’ts’ of vaccination in adults with AIIRD.

Treating to target in psoriatic arthritis: how to implement in clinical practice

2015 ◽  
Vol 75 (4) ◽  
pp. 640-643 ◽  
Author(s):  
Laura C Coates ◽  
Philip S Helliwell
Keyword(s):  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Standard Of Care ◽  
Routine Clinical Practice ◽  
Tight Control ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Medical Specialities ◽  
Optimal Measure ◽  
European League

Treating to target is becoming the standard of care in many medical specialities, including rheumatology. The Tight Control of Psoriatic Arthritis (TICOPA) trial has recently provided evidence of the benefit of treating to target in psoriatic arthritis (PsA), and the revised European League Against Rheumatism (EULAR) recommendations on the management of PsA suggest this approach. However, the question of the optimal measure to use and the practicalities of incorporating this into routine clinical practice remain problematic.

Antiphospholipid syndrome: diagnosis, development, therapy.

2020 ◽  
Author(s):  
Т.М. Решетняк ◽  
Ф.А. Чельдиева ◽  
К.C. Нурбаева ◽  
А.М. Лила ◽  
Е.Л. Насонов
Keyword(s):  
Immunosuppressive Therapy ◽  
Antiphospholipid Syndrome ◽  
European League Against Rheumatism ◽  
Syndrome Diagnosis ◽  
Prevention And Treatment ◽  
Development Therapy ◽  
European League

Приведен обзор литературы по механизму развития антифосфолипидного синдрома (АФС), тактика терапии. Представлены последние рекомендации Европейской антиревматической лиги (англ. European League Against Rheumatism, EULAR) по профилактике и лечению тромбозов при АФС. Обсуждены вопросы целесообразности терапии иммуносупрессивными препаратами при АФС. The review is dedicated the development and the treatment of antiphospholipid syndrome (APS), and the content of the recent guidelines of European League Against Rheumatism (EULAR) for prevention and treatment of thrombosis in APS. The immunosuppressive therapy advisability in APS is discussed.

scholarly journals EULAR recommendations for the management of primary small and medium vessel vasculitis

2008 ◽  
Vol 68 (3) ◽  
pp. 310-317 ◽  
Author(s):  
C Mukhtyar ◽  
L Guillevin ◽  
M C Cid ◽  
B Dasgupta ◽  
K de Groot ◽  
...  
Keyword(s):  
Delphi Technique ◽  
Everyday Clinical Practice ◽  
Drug Regulatory Agency ◽  
Modified Delphi ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
The Usa ◽  
Modified Delphi Technique ◽  
European League

Objectives:To develop European League Against Rheumatism (EULAR) recommendations for the management of small and medium vessel vasculitis.Methods:An expert group (consisting of 10 rheumatologists, 3 nephrologists, 2 immunologists, 2 internists representing 8 European countries and the USA, a clinical epidemiologist and a representative from a drug regulatory agency) identified 10 topics for a systematic literature search using a modified Delphi technique. In accordance with standardised EULAR operating procedures, recommendations were derived for the management of small and medium vessel vasculitis. In the absence of evidence, recommendations were formulated on the basis of a consensus opinion.Results:In all, 15 recommendations were made for the management of small and medium vessel vasculitis. The strength of recommendations was restricted by low quality of evidence and by EULAR standardised operating procedures.Conclusions:On the basis of evidence and expert consensus, recommendations have been made for the evaluation, investigation, treatment and monitoring of patients with small and medium vessel vasculitis for use in everyday clinical practice.

scholarly journals 2018 Update of the EULAR recommendations for the management of large vessel vasculitis

2019 ◽  
Vol 79 (1) ◽  
pp. 19-30 ◽  
Author(s):  
Bernhard Hellmich ◽  
Ana Agueda ◽  
Sara Monti ◽  
Frank Buttgereit ◽  
Hubert de Boysson ◽  
...  
Keyword(s):  
Task Force ◽  
Scientific Evidence ◽  
Clinical Care ◽  
Large Vessel Vasculitis ◽  
Large Vessel ◽  
High Dose ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Increased Risk ◽  
European League

BackgroundSince the publication of the European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) in 2009, several relevant randomised clinical trials and cohort analyses have been published, which have the potential to change clinical care and therefore supporting the need to update the original recommendations.MethodsUsing EULAR standardised operating procedures for EULAR-endorsed recommendations, the EULAR task force undertook a systematic literature review and sought opinion from 20 experts from 13 countries. We modified existing recommendations and created new recommendations.ResultsThree overarching principles and 10 recommendations were formulated. We recommend that a suspected diagnosis of LVV should be confirmed by imaging or histology. High dose glucocorticoid therapy (40–60 mg/day prednisone-equivalent) should be initiated immediately for induction of remission in active giant cell arteritis (GCA) or Takayasu arteritis (TAK). We recommend adjunctive therapy in selected patients with GCA (refractory or relapsing disease, presence of an increased risk for glucocorticoid-related adverse events or complications) using tocilizumab. Methotrexate may be used as an alternative. Non-biological glucocorticoid-sparing agents should be given in combination with glucocorticoids in all patients with TAK and biological agents may be used in refractory or relapsing patients. We no longer recommend the routine use of antiplatelet or anticoagulant therapy for treatment of LVV unless it is indicated for other reasons.ConclusionsWe have updated the recommendations for the management of LVV to facilitate the translation of current scientific evidence and expert opinion into better management and improved outcome of patients in clinical practice.

scholarly journals European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update

2015 ◽  
Vol 75 (3) ◽  
pp. 499-510 ◽  
Author(s):  
L Gossec ◽  
J S Smolen ◽  
S Ramiro ◽  
M de Wit ◽  
M Cutolo ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Expert Opinion ◽  
Pharmacological Treatment ◽  
Task Force ◽  
Local Therapy ◽  
Initial Therapy ◽  
Tnf Inhibitor ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
European League

BackgroundSince the publication of the European League Against Rheumatism recommendations for the pharmacological treatment of psoriatic arthritis (PsA) in 2012, new evidence and new therapeutic agents have emerged. The objective was to update these recommendations.MethodsA systematic literature review was performed regarding pharmacological treatment in PsA. Subsequently, recommendations were formulated based on the evidence and the expert opinion of the 34 Task Force members. Levels of evidence and strengths of recommendations were allocated.ResultsThe updated recommendations comprise 5 overarching principles and 10 recommendations, covering pharmacological therapies for PsA from non-steroidal anti-inflammatory drugs (NSAIDs), to conventional synthetic (csDMARD) and biological (bDMARD) disease-modifying antirheumatic drugs, whatever their mode of action, taking articular and extra-articular manifestations of PsA into account, but focusing on musculoskeletal involvement. The overarching principles address the need for shared decision-making and treatment objectives. The recommendations address csDMARDs as an initial therapy after failure of NSAIDs and local therapy for active disease, followed, if necessary, by a bDMARD or a targeted synthetic DMARD (tsDMARD). The first bDMARD would usually be a tumour necrosis factor (TNF) inhibitor. bDMARDs targeting interleukin (IL)12/23 (ustekinumab) or IL-17 pathways (secukinumab) may be used in patients for whom TNF inhibitors are inappropriate and a tsDMARD such as a phosphodiesterase 4-inhibitor (apremilast) if bDMARDs are inappropriate. If the first bDMARD strategy fails, any other bDMARD or tsDMARD may be used.ConclusionsThese recommendations provide stakeholders with an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes in PsA, based on a combination of evidence and expert opinion.

Patient and rheumatologist perspectives on glucocorticoids: an exercise to improve the implementation of the European League Against Rheumatism (EULAR) recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases

2009 ◽  
Vol 69 (6) ◽  
pp. 1015-1021 ◽  
Author(s):  
M C van der Goes ◽  
J W G Jacobs ◽  
M Boers ◽  
T Andrews ◽  
M A M Blom-Bakkers ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Diseases ◽  
Adverse Events ◽  
Work Experience ◽  
Research Agenda ◽  
International Forum ◽  
Eular Recommendations ◽  
Systemic Glucocorticoid ◽  
European League Against Rheumatism ◽  
European League

ObjectiveTo explore perspectives among patients and rheumatologists on glucocorticoid (GC) therapy and European League Against Rheumatism (EULAR) recommendations on the management of systemic GC therapy in order to enhance implementation of the recommendations.MethodsRheumatologists (from eight countries) and patients (from five countries) acquainted with GCs participated in separate meetings, during which positive and negative aspects of GC therapy were discussed and possible adverse events (AEs) were ranked for importance; in addition participants were asked to evaluate the published EULAR recommendations. The reports from these meetings and themes related to implementation of the recommendations were discussed during an international forum of the experts who had formulated the recommendations and patient participants.ResultsIn all, 140 patients (78% women; mean age 53 years; 61% patients with rheumatoid arthritis) and 110 rheumatologists (mean work experience 15 years) participated in the meetings. Osteoporosis, diabetes and cardiovascular diseases were ranked among the five most worrisome AEs by patients and rheumatologists. In both groups, there was agreement with most of the recommendations; the recommendations on GC information cards and GC use during pregnancy scored lowest. Ideas to improve implementation of the recommendations and a research agenda were generated.ConclusionThe patient and rheumatologist views on GCs corresponded to a large extent, reflected by concerns in both groups about osteoporosis, diabetes and cardiovascular diseases. Specific problems with the EULAR recommendations were identified and addressed to improve their implementation. This exercise shows that patient and rheumatologist perspectives should be included early in the process of formulating recommendations.

scholarly journals European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies

2011 ◽  
Vol 71 (1) ◽  
pp. 4-12 ◽  
Author(s):  
L Gossec ◽  
J S Smolen ◽  
C Gaujoux-Viala ◽  
Z Ash ◽  
H Marzo-Ortega ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Research Agenda ◽  
Task Force ◽  
Optimal Outcomes ◽  
Eular Recommendations ◽  
Evidence Strength ◽  
European League Against Rheumatism ◽  
Combining Evidence ◽  
Musculoskeletal Manifestations ◽  
European League

BackgroundPsoriatic arthritis (PsA) is a clinically heterogeneous disease. Clear consensual treatment guidance focused on the musculoskeletal manifestations of PsA would be advantageous. The authors present European League Against Rheumatism (EULAR) recommendations for the treatment of PsA with systemic or local (non-topical) symptomatic and disease-modifying antirheumatic drugs (DMARD).MethodsThe recommendations are based on evidence from systematic literature reviews performed for non-steroidal anti-inflammatory drugs (NSAID), glucocorticoids, synthetic DMARD and biological DMARD. This evidence was discussed, summarised and recommendations were formulated by a task force comprising 35 representatives, and providing levels of evidence, strength of recommendations and levels of agreement.ResultsTen recommendations were developed for treatment from NSAID through synthetic DMARD to biological agents, accounting for articular and extra-articular manifestations of PsA. Five overarching principles and a research agenda were defined.ConclusionThese recommendations are intended to provide rheumatologists, patients and other stakeholders with a consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes, based on combining evidence and expert opinion. The research agenda informs directions within EULAR and other communities interested in PsA.

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