制定类风湿关节炎药物治疗的最新指南。
我们开发了临床相关人群,干预,比较器,和结果(PICO)问题。在进行了系统的文献综述后,建议评估的等级,使用开发和评估(GRADE)方法对证据的确定性进行评级。由临床医生和患者组成的投票小组就建议的方向(赞成或反对)和强度(有力或有条件的)达成了共识。
该指南涉及改善疾病的抗风湿药(DMARDs)的治疗,包括常规合成DMARDs,生物DMARDs,和有针对性的合成DMARDs,使用糖皮质激素,以及在某些高风险人群中使用DMARDs(即,那些患有肝病的人,心力衰竭,淋巴增生性疾病,以前的严重感染,和非结核性分枝杆菌肺病)。该准则包括44项建议(7项强有力的建议和37项有条件的建议)。
本临床实践指南旨在作为支持临床医生和患者决策的工具。建议不是规定性的,个人治疗决策应通过基于患者价值观的共同决策过程做出,目标,preferences,和合并症。
To develop updated
guidelines for the pharmacologic management of rheumatoid arthritis.
We developed clinically relevant population, intervention, comparator, and outcomes (PICO) questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A voting panel comprising clinicians and patients achieved
consensus on the direction (for or against) and strength (strong or conditional) of recommendations.
The
guideline addresses treatment with disease-modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs, use of glucocorticoids, and use of DMARDs in certain high-risk populations (i.e., those with liver disease, heart failure, lymphoproliferative disorders, previous serious infections, and nontuberculous mycobacterial lung disease). The
guideline includes 44 recommendations (7 strong and 37 conditional).
This clinical practice
guideline is intended to serve as a tool to support clinician and patient decision-making. Recommendations are not prescriptive, and individual treatment decisions should be made through a shared decision-making process based on patients\' values, goals, preferences, and comorbidities.