TY - JOUR 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 DO - 10.3899/jrheum.220209 SP - jrheum.220209 AU - Glen S Hazlewood AU - Jordi Pardo Pardo AU - Cheryl Barnabe AU - Orit Schieir AU - Claire E.H. Barber AU - Laurie Proulx AU - Dawn P. Richards AU - Peter Tugwell AU - Nick Bansback AU - Pooneh Akhavan AU - Claire Bombardier AU - Vivian Bykerk AU - Shahin Jamal AU - Majed Khraishi AU - Regina Taylor-Gjevre AU - Carter Thorne AU - Arnav Agarwal AU - Janet E Pope Y1 - 2022/07/15 UR - http://www.jrheum.org/content/early/2022/07/14/jrheum.220209.abstract N2 - 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). ER -