Research ArticleAccepted Article
Open Access
Canadian Rheumatology Association living guidelines for the pharmacological management of rheumatoid arthritis with disease-modifying anti-rheumatic drugs
Glen S Hazlewood, Jordi Pardo Pardo, Cheryl Barnabe, Orit Schieir, Claire E.H. Barber, Laurie Proulx, Dawn P. Richards, Peter Tugwell, Nick Bansback, Pooneh Akhavan, Claire Bombardier, Vivian Bykerk, Shahin Jamal, Majed Khraishi, Regina Taylor-Gjevre, Carter Thorne, Arnav Agarwal and Janet E Pope
The Journal of Rheumatology July 2022, jrheum.220209; DOI: https://doi.org/10.3899/jrheum.220209
Glen S Hazlewood
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Jordi Pardo Pardo
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Cheryl Barnabe
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Orit Schieir
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Claire E.H. Barber
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Laurie Proulx
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Dawn P. Richards
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Peter Tugwell
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Nick Bansback
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Pooneh Akhavan
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Claire Bombardier
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Vivian Bykerk
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Shahin Jamal
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Majed Khraishi
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Regina Taylor-Gjevre
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Carter Thorne
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Arnav Agarwal
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Janet E Pope
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Vancouver, BC, Canada; Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, New York, New York; Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada; Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan; The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, ON; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario; Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario. Funding: Funding for this guideline was provided by the Canadian Rheumatology Association. Conflicts of interest: G Hazlewood: None; J Pardo: Funding from Canadian Rheumatology Association to Cochrane Musculoskeletal to provide methodological support for guideline development. C Barnabe: Honoraria for advisory boards (Gilead, Sanofi, Celltrion) and speaker fees (Sanofi) in past 3 years; O Schieir: None; C Barber: None; L Proulx: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. LP has received payment and travel support in the last 3 years from Lilly Canada (sharing patient perspectives at an event); D. Richards: Volunteer Vice President of Canadian Arthritis Patient Alliance which receives the majority of its funding from independent grants from pharmaceutical companies. DR's employer, Five02 Labs Inc, has received payment in the last 3 years from Novo Nordisk Canada (speaking on living with arthritis and arthritis advocacy) and Lilly Canada (sharing patient story, participating in an advisory board); P Tugwell: None; N Bansback: None; P Akhavan: Honoraria for advisory boards (Janssen, Eli Lilly, Pfizer, Sandoz, Celltrion, AbbVie, Roche); C Bombardier: Consulting for Novartis, Samsung. Honoraria for AbbVie, Janssen, Merck, Pfizer, GSK, Mylan; V Bykerk: Consultant: Amgen, BMS, Gilead, Genzyme, Regeneron, UCB; Research funding: Amgen, BMS, Genzyme, Pfizer, Sanofi Aventis, UCB; S Jamal: Honoraria for advisory boards (Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Teva, UCB); M Khraishi: Consulting for Amgen, Abbvie, Celgene, Merck, Novartis, Pfizer, Gilead; R Taylor-Gjevre: None; C Thorne: Consulting for Celgene, AbbVie, Merck, Pfizer, Sandoz; A Agarwal: None; JE Pope: Consulting for AbbVie, Amgen, BI, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medexus, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, UCB, VIatris. Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Abstract
Objective To provide the initial installment of a living guideline that will provide up-to-date guidance on the pharmacological management of patients with rheumatoid arthritis (RA) in Canada.
Methods The Canadian Rheumatology Association (CRA) formed a multidisciplinary panel composed of rheumatologists, researchers, methodologists, and patients. In this first installment of our living guideline, the panel developed a recommendation for tapering of biologic and targeted synthetic (b/ts) DMARD therapy in patients in sustained remission using the GRADE approach, including a health equity framework developed for the Canadian RA population. The recommendation was adapted from a living guideline of the Australia & New Zealand Musculoskeletal Clinical Trials Network.
Results In people with RA who are in sustained low disease activity or remission for at least 6 months, we suggest offering stepwise reduction in the dose of b/tsDMARD without discontinuation, in the context of a shared decision, provided patients are able to rapidly access rheumatology care and re-establish their medications if needed. In patients where rapid access to care or re-establishing access to medications is challenging, we conditionally recommend against tapering. A patient decision aid was developed to complement the recommendation.
Conclusion This living guideline will provide contemporary RA management recommendations for Canadian practice. New recommendations will be added over time and updated, with the latest recommendation, evidence summaries and evidence to decision summaries available through the CRA website (www.rheum.ca).
In this issue
The Journal of Rheumatology
Vol. 50, Issue 2
1 Feb 2023
Accepted manuscript
Canadian Rheumatology Association living guidelines for the pharmacological management of rheumatoid arthritis with disease-modifying anti-rheumatic drugs
Glen S Hazlewood, Jordi Pardo Pardo, Cheryl Barnabe, Orit Schieir, Claire E.H. Barber, Laurie Proulx, Dawn P. Richards, Peter Tugwell, Nick Bansback, Pooneh Akhavan, Claire Bombardier, Vivian Bykerk, Shahin Jamal, Majed Khraishi, Regina Taylor-Gjevre, Carter Thorne, Arnav Agarwal, Janet E Pope
The Journal of Rheumatology Jul 2022, jrheum.220209; DOI: 10.3899/jrheum.220209
Accepted manuscript
Canadian Rheumatology Association living guidelines for the pharmacological management of rheumatoid arthritis with disease-modifying anti-rheumatic drugs
Glen S Hazlewood, Jordi Pardo Pardo, Cheryl Barnabe, Orit Schieir, Claire E.H. Barber, Laurie Proulx, Dawn P. Richards, Peter Tugwell, Nick Bansback, Pooneh Akhavan, Claire Bombardier, Vivian Bykerk, Shahin Jamal, Majed Khraishi, Regina Taylor-Gjevre, Carter Thorne, Arnav Agarwal, Janet E Pope
The Journal of Rheumatology Jul 2022, jrheum.220209; DOI: 10.3899/jrheum.220209
