New and highly effective DMARDs have continued to emerge until the most recent yearsin particular, biological agents which target tumour necrosis factor, the interleukin 1 (IL-1) receptor, the IL-6 receptor, B lymphocytes and T-cell costimulation.1 In addition, a chemical DMARD, leflunomide, has become available and compounds which have been in use for many decades, such as methotrexate (MTX) and sulfasalazine (SSZ), as well as GCs, have been re-examined in order to accomplish better efficacy. of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion. Introduction The management of rheumatoid arthritis (RA) rests on several principles. Drug treatment, which comprises disease-modifying antirheumatic drugs (DMARDs), but also non-steroidal anti-inflammatory drugs and glucocorticoids (GCs), as well as non-pharmacological steps, such as physical, occupational and psychological Big Endothelin-1 (1-38), human therapeutic methods, together may lead to therapeutic success. However, the mainstay of RA treatment Big Endothelin-1 (1-38), human is the application of DMARDs. Big Endothelin-1 (1-38), human It is DMARD treatment, especially, which has undergone dramatic changes during the past decade, providing previously unforeseen therapeutic sizes. New and highly effective DMARDs have continued to emerge until the most recent yearsin particular, biological agents which target tumour necrosis factor, the interleukin 1 (IL-1) receptor, the IL-6 receptor, B lymphocytes and T-cell costimulation.1 In addition, a chemical DMARD, leflunomide, has become available and compounds which have been in use for many decades, such as methotrexate (MTX) and sulfasalazine (SSZ), as well as GCs, have been re-examined in order to accomplish better efficacy. For example, the use of high dose MTX2 and the disease-modifying effects of GCs, especially when combined with traditional DMARDs, 3C7 are now well established. Furthermore, treatment strategies have changed during this period, in the beginning by calling for early referral and early institution of DMARD treatment on the basis of respective evidence of clinical efficacy,8C10 and later by showing that tight control using composite steps of disease activity and appropriate switching of drug treatment are highly efficacious approaches.11C14 While all these data of clinical and observational trials on drugs and strategies have been highly enlightening, patients and rheumatologists are currently overwhelmed by this information which does not always allow one to decide easily and conclusively which path to follow when initiating or changing therapeutic strategies in patients with RA. Indeed, some inconsistencies in therapeutic targets and strategies among rheumatologists have been recognised in a survey performed at a recent annual European Congress of Rheumatology.15 These inconsistencies may be partly based Cdh15 on differences in attitudes among doctors caring for patients with RA, settings (academic centres vs private practice), patient preferences and reimbursement policies. Information on the current state of evidence for the efficacy of different brokers or therapeutic strategies may also not always be regarded as sufficiently total or available. Along these lines, the European League Against Rheumatism (EULAR) has recently formulated major objectives, which among other aspects specify that by 2012, EULAR will have provided standards of care and foster access to optimal care of people with musculoskeletal conditions in Europe.16 Since disease modification constitutes the most important therapeutic intervention in RA, it was the objective of this EULAR Task Force to find a consensus on recommendations for the management of RA with synthetic and biological DMARDs. Methods The task pressure aimed at aggregating available information on disease modification in RA into practical recommendations. The basis of the activities of the task force were the EULAR standardised operating procedures for the development of recommendations,17 which suggest the institution of an expert committee in charge of consensus finding on the basis of evidence provided by a systematic literature evaluate (SLR) and expert opinion. The task of developing management recommendations for RA was regarded as large and therefore warranted division of the topic into five main areas: (GCs; (This statement stems from the evidence that patients with RA followed up by rheumatologists, in comparison with other doctors, are diagnosed earlier, receive DMARD treatment more frequently and have better outcomes in all major characteristics of RA, in particular joint damage and physical function.24C28 Rheumatologists check the disease activity of their patients with RA with appropriate instruments and are well aware of the indications, contraindications and adverse effects of DMARDs; this has become of particular importance with the introduction of modern treatments and strategies. Therefore, patients with inflammatory arthritis, in general, and suspected RA, in particular, should be.
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