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Recommendations of the French Society for Rheumatology for managing rheumatoid arthritis

2014; Elsevier BV; Volume: 81; Issue: 4 Linguagem: Inglês

10.1016/j.jbspin.2014.05.002

1778-7254

C. Gaujoux-Viala, Laure Gossec, Alain Cantagrel, Maxime Dougados, Bruno Fautrel, Xavier Mariette, Henri Nataf, Alain Saraux, Sonia Tropé, Bernard Combe,

Systemic Lupus Erythematosus Research

This article reports the latest recommendations of the French Society for Rheumatology (SFR) regarding the management of rheumatoid arthritis (RA). New recommendations were developed by hospital- and community-based rheumatologists having extensive experience with RA and a patient self-help organization representative. They rest on the recently issued EULAR recommendations and a literature review. Points emphasized in the 15 recommendations include the need to share treatment decisions between the rheumatologist and the patient, the acquisition by patients of self-management skills, remission or minimal disease activity as the treatment target, the need for initiating disease-modifying drugs as early as possible, and the usefulness of regular disease activity assessments to allow rapid treatment adjustments if needed (i.e., tight disease control). First-line methotrexate monotherapy is recommended, with concomitant short-term glucocorticoid therapy if indicated by the risk/benefit ratio. Patients who fail this approach (no response after 3 months or target not achieved after 6 months) can be considered for another synthetic disease-modifying antirheumatic drug (DMARD: leflunomide or sulfasalazine), combined synthetic DMARD therapy, or methotrexate plus a biologic, depending on the prognostic factors and patient characteristics. If the first biologic fails, switching to a second biologic is recommended. In the event of a sustained remission, cautious dosage reduction of the biological and/after synthetic DMARDs is in order. These recommendations are designed to improve the management of patients with RA.