Singh Jasvinder A, Saag Kenneth G, Bridges S Louis, Akl Elie A, Bannuru Raveendhara R, Sullivan Matthew C, Vaysbrot Elizaveta, McNaughton Christine, Osani Mikala, Shmerling Robert H, Curtis Jeffrey R, Furst Daniel E, Parks Deborah, Kavanaugh Arthur, O'Dell James, King Charles, Leong Amye, Matteson Eric L, Schousboe John T, Drevlow Barbara, Ginsberg Seth, Grober James, St Clair E William, Tindall Elizabeth, Miller Amy S, McAlindon Timothy
University of Alabama at Birmingham.
American University of Beirut, Beirut, Lebanon, and McMaster University, Hamilton, Ontario, Canada.
Arthritis Care Res (Hoboken). 2016 Jan;68(1):1-25. doi: 10.1002/acr.22783. Epub 2015 Nov 6.
To develop a new evidence-based, pharmacologic treatment guideline for rheumatoid arthritis (RA).
We conducted systematic reviews to synthesize the evidence for the benefits and harms of various treatment options. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence. We employed a group consensus process to grade the strength of recommendations (either strong or conditional). A strong recommendation indicates that clinicians are certain that the benefits of an intervention far outweigh the harms (or vice versa). A conditional recommendation denotes uncertainty over the balance of benefits and harms and/or more significant variability in patient values and preferences.
The guideline covers the use of traditional disease-modifying antirheumatic drugs (DMARDs), biologic agents, tofacitinib, and glucocorticoids in early (<6 months) and established (≥6 months) RA. In addition, it provides recommendations on using a treat-to-target approach, tapering and discontinuing medications, and the use of biologic agents and DMARDs in patients with hepatitis, congestive heart failure, malignancy, and serious infections. The guideline addresses the use of vaccines in patients starting/receiving DMARDs or biologic agents, screening for tuberculosis in patients starting/receiving biologic agents or tofacitinib, and laboratory monitoring for traditional DMARDs. The guideline includes 74 recommendations: 23% are strong and 77% are conditional.
This RA guideline should serve as a tool for clinicians and patients (our two target audiences) for pharmacologic treatment decisions in commonly encountered clinical situations. These recommendations are not prescriptive, and the treatment decisions should be made by physicians and patients through a shared decision-making process taking into account patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
制定一项新的基于证据的类风湿关节炎（RA）药物治疗指南。
我们进行了系统评价，以综合各种治疗方案的益处和危害的证据。我们使用推荐分级评估、制定和评价（GRADE）方法对证据质量进行评级。我们采用小组共识过程对推荐强度进行分级（强推荐或有条件推荐）。强推荐表明临床医生确信一种干预措施的益处远大于危害（反之亦然）。有条件推荐表示在益处和危害的平衡方面存在不确定性，和/或患者价值观和偏好方面存在更大的变异性。
该指南涵盖了传统改善病情抗风湿药（DMARDs）、生物制剂、托法替布和糖皮质激素在早期（<6个月）和确诊（≥6个月）RA中的应用。此外，它还提供了关于采用达标治疗方法、药物减量和停药，以及在患有肝炎、充血性心力衰竭、恶性肿瘤和严重感染的患者中使用生物制剂和DMARDs的建议。该指南涉及开始/接受DMARDs或生物制剂的患者中疫苗的使用、开始/接受生物制剂或托法替布的患者中结核病的筛查，以及传统DMARDs的实验室监测。该指南包括74条推荐：23%为强推荐，77%为有条件推荐。
本RA指南应作为临床医生和患者（我们的两个目标受众）在常见临床情况下进行药物治疗决策的工具。这些推荐并非指令性的，治疗决策应由医生和患者通过共同决策过程做出，同时考虑患者的价值观、偏好和合并症。这些推荐不应被用于限制或拒绝治疗。
