The Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, Canada.
J Rheumatol. 2012 Aug;39(8):1583-602. doi: 10.3899/jrheum.120165. Epub 2012 Jun 15.
The Canadian Rheumatology Association (CRA) has developed recommendations for the pharmacological management of rheumatoid arthritis (RA) with traditional and biologic disease-modifying antirheumatic drugs (DMARD) in 2 parts. Part II, focusing on specific safety aspects of treatment with traditional and biologic DMARD in patients with RA, is reported here.
Key questions were identified a priori based on results of a national needs-assessment survey. A systematic review of all clinical practice guidelines and consensus statements regarding treatment with traditional and biologic DMARD in patients with RA published between January 2000 and June 2010 was performed in Medline, Embase, and CINAHL databases, and was supplemented with a "grey literature" search including relevant public health guidelines. Systematic reviews of postmarketing surveillance and RA registry studies were performed to update included guideline literature reviews as appropriate. Guideline quality was independently assessed by 2 reviewers. Guideline characteristics, recommendations, and supporting evidence from observational studies and randomized trials were synthesized into evidence tables. The working group voted on recommendations using a modified Delphi technique.
Thirteen recommendations addressing perioperative care, screening for latent tuberculosis infection prior to the initiation of biologic DMARD, optimal vaccination practices, and treatment of RA patients with active or a history of malignancy were developed for rheumatologists, other primary prescribers of RA drug therapies, and RA patients.
These recommendations were developed based on a synthesis of international RA and public health guidelines, supporting evidence, and expert consensus in the context of the Canadian health system. They are intended to help promote best practices and improve healthcare delivery for persons with RA.
加拿大风湿病学会（CRA）已经制定了关于类风湿关节炎（RA）药物治疗的建议，包括传统和生物疾病修饰抗风湿药物（DMARD），共分为两部分。本文报告第二部分，重点介绍RA患者使用传统和生物 DMARD 治疗的特定安全性方面。
根据全国需求评估调查的结果，预先确定了关键问题。在 Medline、Embase 和 CINAHL 数据库中对 2000 年 1 月至 2010 年 6 月期间发表的关于 RA 患者使用传统和生物 DMARD 治疗的所有临床实践指南和共识声明进行了系统性回顾，并补充了相关公共卫生指南的“灰色文献”搜索。对上市后监测和 RA 登记研究进行了系统评价，以更新纳入的指南文献综述。指南质量由 2 名评审员独立评估。将观察性研究和随机试验的指南特征、建议和支持证据综合到证据表中。工作组使用改良 Delphi 技术对建议进行投票。
针对围手术期护理、生物 DMARD 治疗前潜伏性结核感染筛查、最佳疫苗接种实践以及治疗活动性或有恶性肿瘤病史的 RA 患者，制定了针对风湿病学家、RA 药物治疗的其他初级处方者和 RA 患者的 13 项建议。
这些建议是在加拿大卫生系统背景下，综合国际 RA 和公共卫生指南、支持证据和专家共识制定的，旨在帮助促进最佳实践并改善 RA 患者的医疗服务。
