To the Editor:
We have updated the Canadian Rheumatology Association (CRA) guidelines for rheumatoid arthritis (RA) with 3 recommendations for the use of glucocorticoids (GCs). The recommendations address the use of short-term GCs for RA flares or as bridging therapy when disease-modifying antirheumatic drugs (DMARDs) are initiated or changed, and the use of long-term GCs as adjuncts to DMARDs. These add to our prior Best Practice Statements and existing treatment recommendations. The full list of recommendations and Best Practice Statements are presented in the Table.
Full list of current CRA treatment recommendations for the management of rheumatoid arthritis.
We continue to host the full version of the guideline with supporting evidence via an interactive web-based platform for guideline authoring and publication (MAGICapp).1 The online version includes the full evidence-to-decision framework that summarizes the evidence and rationale for each recommendation according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidance.2 We also include practical information for implementation. For the GC recommendations, this includes common dosing regimens and other practical points related to prescribing. The recommendations and statements were developed using the GRADE-ADOLOPMENT approach,3 with source recommendations from the Australia & New Zealand Musculoskeletal Clinical Trials Network.4
How to cite the CRA Living Guidelines for RA. When citing the guidelines, both the original journal publication5 and online MAGICapp version1 should be cited, as these outline the full methods of development. Authors may choose to also cite this publication or other update articles.6
Footnotes
Funding for this guideline was provided by the Canadian Rheumatology Association (CRA).
JPP received funding from CRA to Cochrane Musculoskeletal to provide methodological support for guideline development. JEP received consulting fees from AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, and Viatris.
C. Barnabe received honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi, Amgen, Janssen, Fresenius Kabi, Pfizer) in past 3 years. SJ received honoraria for advisory boards from AbbVie, Amgen, BMS, BI, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, and UCB. BK received honoraria for advisory boards from Pfizer and presentation fees from AbbVie. PA received honoraria for advisory boards from Janssen, Sandoz, and AbbVie. JCT received consulting fees from Celgene, AbbVie, Biogen, Jamp, Nordic, Pfizer, Roche, and Sandoz. C. Bombardier received consulting fees and honoraria from GSK. VB received consulting fees from BMS, Gilead, AbbVie, and Pfizer. MK received consulting fees from AbbVie, Lilly, Novartis, Otsuka, and Pfizer. LP is the Managing Director (part-time) of Canadian Arthritis Patient Alliance (CAPA), which receives the majority of its funding from independent grants from pharmaceutical companies; and held a contract position with Health Canada in the Canadian Drug Agency Transition Office. DPR is a Volunteer Vice President of CAPA, which receives the majority of its funding from independent grants from pharmaceutical companies. Since 2023, she has been a member of the Canadian Drug Agency Transition Office’s Appropriate Use Advisory Committee. PT is an advisory committee member of the Canadian Reformulary Group Inc., a company that reviews the evidence for health insurance companies’ employer drug plans. The remaining authors declare no conflicts of interest relevant to this article.
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