The objective of this study was to identify the pharmacologic treatment guidelines for rheumatoid arthritis based on evidence. As a part of this study, systematic reviews were conducted to understand the harms and benefits of varied treatments. In this process, GRADE or Grading of the Recommendations Assessment, Development, and Evaluation methodology was used to draw an inference. A group of consensus processes was employed to grade the recommendations on the basis of their strength. The clinicians in strong recommendations were certain about the benefits of an intervention that outweigh harms or vice versa. In the conditional recommendation, the uncertainty in terms of the balance of benefits and harms or variability of values and preferences in values was observed.
In the guideline, traditionally used disease-modifying antirheumatic drugs (DMARDs) were covered along with tofacitinib, biologic agents, and glucocorticoids in early (<6 months) and established (≥6 months) stages of Rheumatoid Arthritis (RA). The guideline further consisted of identification of target-to-target approach, the use of biologic agents, and DMARDs, and serious infections. It was found that out of 74 recommendations, 23% were strong and 77% were conditional.
Hence, it was concluded that the RA guideline must act as a tool for patients as well as clinicians to proceed with the pharmacological decision-making is commonly noticed clinical situations. Besides, it was determined that these recommendations should be a collaborative decision-making process for physicians and patients. These should not be used as a limitation or considered for denying therapeutic access.
Ref Link:onlinelibrary.wiley.com/doi/10.1002/art.39480
