G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Professor, C.E.H. Barber, MD, PhD, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada;
J. Pardo Pardo, Ldo, Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada.
J Rheumatol. 2022 Oct;49(10):1092-1099. doi: 10.3899/jrheum.220209. Epub 2022 Jul 15.
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.
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 the tapering of biologic and targeted synthetic disease-modifying antirheumatic drug (b/ts DMARD) therapy in patients in sustained remission using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) 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.
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 reestablish their medications if needed. In patients where rapid access to care or reestablishing access to medications is challenging, we conditionally recommend against tapering. A patient decision aid was developed to complement the recommendation.
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).
提供一份关于加拿大类风湿关节炎（RA）患者药物治疗管理的最新指导原则，作为该指南的初始内容。
加拿大风湿病学会（CRA）组织了一个由风湿病学家、研究人员、方法学家和患者组成的多学科小组。在本指南的第一部分中，该小组使用 GRADE（推荐评估、制定与评价）方法制定了关于持续缓解患者生物制剂和靶向合成疾病修饰抗风湿药物（b/ts DMARD）减药的推荐意见，包括为加拿大 RA 人群开发的健康公平框架。该建议改编自澳大利亚和新西兰肌肉骨骼临床试验网络的一项实时指南。
对于至少持续 6 个月低疾病活动度或缓解的 RA 患者，我们建议在共同决策的情况下，逐步减少 b/tsDMARD 的剂量而不停药，前提是患者能够快速获得风湿病学治疗并在需要时重新开始使用药物。在患者快速获得治疗或重新获得药物治疗有困难的情况下，我们有条件地不建议减药。制定了患者决策辅助工具以补充该建议。
本实时指南将为加拿大的临床实践提供当代 RA 管理建议。随着时间的推移，将添加新的建议并进行更新，通过 CRA 网站（www.rheum.ca）可获得最新建议、证据摘要和决策证据摘要。
