What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines
File version
Version of Record (VoR)
Author(s)
Bunzli, Samantha
Bullen, Jonathan
O'Brien, Penny
Persaud, Jennifer
Gunatillake, Tilini
Nikpour, Mandana
Grainger, Rebecca
Barnabe, Cheryl
Lin, Ivan
Griffith University Author(s)
Primary Supervisor
Other Supervisors
Editor(s)
Date
Size
File type(s)
Location
Abstract
Abstract: Systematic review to evaluate the quality of the clinical practice guidelines (CPG) for rheumatoid arthritis (RA) management and to provide a synthesis of high-quality CPG recommendations, highlighting areas of consistency, and inconsistency. Electronic searches of five databases and four online guideline repositories were performed. RA management CPGs were eligible for inclusion if they were written in English and published between January 2015 and February 2022; focused on adults ≥ 18 years of age; met the criteria of a CPG as defined by the Institute of Medicine; and were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II instrument. RA CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organization of care and did not include interventional management recommendations; and/or included other arthritic conditions. Of 27 CPGs identified, 13 CPGs met eligibility criteria and were included. Non-pharmacological care should include patient education, patient-centered care, shared decision-making, exercise, orthoses, and a multi-disciplinary approach to care. Pharmacological care should include conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), with methotrexate as the first-line choice. If monotherapy conventional synthetic DMARDs fail to achieve a treatment target, this should be followed by combination therapy conventional synthetic DMARDs (leflunomide, sulfasalazine, hydroxychloroquine), biologic DMARDS and targeted synthetic DMARDS. Management should also include monitoring, pre-treatment investigations and vaccinations, and screening for tuberculosis and hepatitis. Surgical care should be recommended if non-surgical care fails. This synthesis offers clear guidance of evidence-based RA care to healthcare providers. Trial registration: The protocol for this review was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/UB3Y7).
Journal Title
Clinical Rheumatology
Conference Title
Book Title
Edition
Volume
42
Issue
9
Thesis Type
Degree Program
School
Publisher link
Patent number
Funder(s)
Grant identifier(s)
Rights Statement
Rights Statement
© Crown 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Item Access Status
Note
Access the data
Related item(s)
Subject
Health policy
Clinical sciences
Immunology
Allied health and rehabilitation science
Persistent link to this record
Citation
Conley, B; Bunzli, S; Bullen, J; O'Brien, P; Persaud, J; Gunatillake, T; Nikpour, M; Grainger, R; Barnabe, C; Lin, I, What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines, Clinical Rheumatology, 2023, 42 (9), pp. 2267-2278