News Release

ACR updates guidelines for use of DMARDs and biologic drugs in treating rheumatoid arthritis

Peer-Reviewed Publication

Wiley

The American College of Rheumatology (ACR) has released the 2012 recommendations for the use of disease-modifying antirheumatic drugs (DMARDs) and biologic agents in the treatment of rheumatoid arthritis (RA). The guidelines published today in the ACR journal, Arthritis Care & Research, are an update to the 2008 recommendations and address the issues of initiating and switching drugs, screening for tuberculosis (TB) reactivation, immunization, and the use of biologics in high-risk RA patients.

More than one million Americans suffer with RA—a chronic disease that causes pain, swelling and inflammation in the lining of the joints—and 75% of those affected are women according to the ACR. DMARDs such as methotrexate and hydroxychloroquine may be used individually or in combination with biological agents to treat RA. Biological agents include the tumor necrosis factor (TNF) inhibitors adalimumab, cerotlizumab pegol, etanercept, golimumab or infliximab; or the non-TNF biological drugs, abatacept, tocilizumab or rituximab. Biologics should not be used together.

"Effective treatment of RA is essential to control disease progression and improve quality of life for patients," says Dr. Jasvinder Singh with the University of Alabama at Birmingham, the principal investigator for the 2012 update of the ACR RA guidelines for the use of DMARDs and biological agents. "With additional advancements in RA therapies since 2008, it was important to update recommendations that help guide rheumatologists in treating RA patients receiving DMARDs or biologic therapies."

The 2012 DMARD and biologic agents recommendations included a number of areas but concentrated on four updated sections:

  • Indications for use and switching of DMARDs and biologics
  • Use of biologic agents in high-risk RA patients with hepatitis, cancer, or congestive heart failure
  • Screening for TB in RA patients starting or receiving biologic drugs
  • Vaccination in patients starting or receiving DMARDS or biologics

Dr. Singh further explains, "The recommendations for DMARD and biologic treatment provide a guide for rheumatologists who care for RA patients. However, these guidelines should not replace important physician-patient discussions or individual clinical decisions that take into account assessments of risk-benefits, patient preferences, and economic considerations."

The authors suggest that low disease activity or remission should be the goal for each RA patient, but each patient's therapy target should be specific to their particular health needs. One of the noted changes from the 2008 guidelines is more aggressive treatment in patients with early RA that is within six months of symptom onset. Researchers believe the recommended change to more intensive early therapy is that earlier treatment may provide better outcomes; joint damage in RA is irreversible, making prevention of damage an important goal; and preserving physical function and health-related quality of life is necessary to reduce disability.

A related editorial is also available today in Arthritis Care & Research. Co-author Dr. David Daikh, Associate Professor of Clinical Medicine at the University of California, San Francisco and Chief of Rheumatology at the VA Medical Center comments, "The treatment of RA is a rapidly changing field with new therapies regularly becoming available. As this field evolves, the recommendations for treatment with DMARDs and biologic drugs will need to be modified in the future and the ACR must be nimble in keeping these guidelines as current as possible."

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Full citation: "2012 Update of the 2008 American College of Rheumatology Recommendations for the Use of Disease-Modifying Antirheumatic Drugs and Biologic Agents in the Treatment of Rheumatoid Arthritis." Jasvinder A. Singh, Daniel E. Furst, Aseem Bharat, Jeffrey R. Curtis, Arthur F. Kavanaugh, Joel M. Kremer, Larry W. Moreland, James O'Dell, Kevin L. Winthrop, Timothy Beukelman, S. Louis Bridges Jr., W. Winn Chatham, Harold E. Paulus, Maria Suarez-Almazor, Claire Bombardier, Maxime Dougados, Dinesh Khanna, Charles M. King, Amye L. Leong, Eric L. Matteson, John T. Schousboe, Eileen Moynihan, Karen S. Kolba, Archana Jain, Elizabeth R. Volkmann, Harsh Agrawal, Sangmee Bae, Amy S. Mudano, Nivedita M. Patkar, and Kenneth G. Saag.Arthritis Care & Research; Published Online: April 2, 2012 (DOI: 10.1002/acr.21641).

URL Upon publication: http://doi.wiley.com/10.1002/acr.21641.

Editorial: "Updated Recommendations for the Treatment of Rheumatoid Arthritis: Another Step on a Long Road." David I. Daikh and E. William St.Clair..Arthritis Care & Research; Published Online: April 2, 2012 (DOI: 10.1002/acr.21659).

URL Upon publication: http://doi.wiley.com/10.1002/acr.21659.

Author Contact: To arrange an interview with Dr. Singh, please contact Greg Williams with the University of Alabama at Birmingham at gdw@uab.edu or at 205-721-0710.

These studies are published in Arthritis Care & Research. The articles can be found under the 'Publications' section at http://www.rheumatology.org or by contacting healthnews@wiley.com.

About the Journal:

Arthritis Care & Research is an official journal of the American College of Rheumatology (ACR), and the Association of Rheumatology Health Professionals (ARHP), a division of the College. Arthritis Care & Research is a peer-reviewed research publication that publishes both original research and review articles that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with arthritis and related disorders, major topics are evidence-based practice studies, clinical problems, practice guidelines, health care economics, health care policy, educational, social, and public health issues, and future trends in rheumatology practice. The journal is published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR). For more information, please visit http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)2151-4658.

About the Society:

Headquartered in Atlanta, Ga., the American College of Rheumatology (ACR) is an international professional medical society that represents more than 8,500 rheumatologists and rheumatology health professionals. Rheumatologists are internists or pediatricians who are qualified by training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones. Over 50 million Americans — including nearly 300,000 children — suffer from the painful, disabling and sometimes fatal effects of arthritis and rheumatic diseases. Learn more by visiting http://www.rheumatology.org or follow ACR on Twitter at http://twitter.com/acrheum.

About Wiley-Blackwell:

Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit http://www.wileyblackwell.com or our new online platform, Wiley Online Library (http://www.wileyonlinelibrary.com), one of the world's most extensive multidisciplinary collections of online resources, covering life, health, social and physical sciences, and humanities.


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