医学
指南
痹症科
类风湿性关节炎
中止
内科学
背景(考古学)
抗风湿药
物理疗法
人口
家庭医学
重症监护医学
病理
古生物学
生物
环境卫生
作者
Glen Hazlewood,Jordi Pardo Pardo,Cheryl Barnabe,Orit Schieir,Claire Barber,Laurie Proulx,Dawn P. Richards,Peter Tugwell,Nick Bansback,Pooneh Akhavan,Claire Bombardier,Vivian P. Bykerk,Shahin Jamal,Majed Khraishi,Regina M. Taylor-Gjevre,Carter Thorne,Arnav Agarwal,Janet Pope
标识
DOI:10.3899/jrheum.220209
摘要
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).
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