RT Journal Article
SR Electronic
T1 Canadian Rheumatology Association living guidelines for the pharmacological management of rheumatoid arthritis with disease-modifying anti-rheumatic drugs
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.220209
DO 10.3899/jrheum.220209
A1 Glen S  Hazlewood
A1 Jordi Pardo  Pardo
A1 Cheryl Barnabe
A1 Orit Schieir
A1 Claire E.H.  Barber
A1 Laurie Proulx
A1 Dawn P.  Richards
A1 Peter Tugwell
A1 Nick Bansback
A1 Pooneh Akhavan
A1 Claire Bombardier
A1 Vivian Bykerk
A1 Shahin Jamal
A1 Majed Khraishi
A1 Regina Taylor-Gjevre
A1 Carter Thorne
A1 Arnav Agarwal
A1 Janet E  Pope
YR 2022
UL http://www.jrheum.org/content/early/2022/07/14/jrheum.220209.abstract
AB 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).