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  • ACR updates guidelines...

ACR updates guidelines on Management of Rheumatoid Arthritis

Written By : Hina Zahid |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2020-11-18T17:53:58+05:30  |  Updated On 18 Nov 2020 5:53 PM IST
ACR updates guidelines on  Management of Rheumatoid Arthritis
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ATLANTA -- The American College of Rheumatology (ACR) has released its updated guidelines for the Management of Rheumatoid Arthritis (RA) at ACR Convergence, the ACR's annual meeting. The comprehensive, clinical recommendations for pharmacologic treatment of RA includes important updates to the previous guideline released in 2015.

Rheumatoid arthritis (RA) is the most common type of chronic inflammatory arthritis. In RA, the immune system, the body's defense system against disease and injury, is not working properly. RA commonly causes pain and swelling in the wrist and small joints of the hand and feet but can affect almost all joints. Treatments for RA can stop joint pain and swelling and may also prevent joint damage. Early treatment will give patients with RA better long-term results.

While these recommendations focus solely on drug treatments for RA, future ACR guidelines will include non-drug therapies and vaccines. The new guideline was developed by a broad range of stakeholders in RA treatment, including rheumatologists, methodologists, and patients living with the disease.

"Patients with RA were involved at every step of the process and these recommendations truly reflect their perspectives. By including their personal experiences with different therapies, including their effectiveness, ease of use and side effects, the recommendations reflect the ACR's goal of shared decision making between the rheumatologist and patient," says Principal Investigator Liana Fraenkel, MD, MPH, professor adjunct in the Division of Rheumatology, Allergy and Immunology at Yale University School of Medicine. Fraenkel will discuss the recommendations at a press conference on Monday, Nov. 9 at 8:30 a.m. (ET).

Recommendations emphasize:

  • Starting patients on methotrexate and continuing with the treatment instead of rapidly switching to another disease-modifying anti-rheumatic drug (DMARD). "We offer rheumatologists guidance on the nuances of how to really maximize the use of methotrexate in these patients," says Dr. Fraenkel.

New recommendations include:

  • • Minimizing the use of glucocorticoids, or steroids, to treat RA inflammation, due to the serious side effects associated with these drugs. "This conditional recommendation was based on the significant side effects of steroids."
  • • A change from past recommendations to escalate to triple therapy before starting a biologic. "Now, we recommend that rheumatologists add a biologic or a targeted synthetic DMARD instead of switching patients to triple therapy."
  • • New, specific recommendations on drug tapering and treatment of patient populations not covered in previous guidelines, including those with subcutaneous nodules, pulmonary disease, non-alcoholic fatty liver disease, persistent hypogammaglobulinemia and non-tuberculous mycobacterial lung disease. Because patients with RA may develop complications affecting their livers, eyes, lungs and just about every organ system, physicians from other specialties were invited to review clinical questions and provide input to the voting panel.

RA is a complex disease that may affect patients in different ways, so rheumatologists often need to individualize management approaches and decision making. Also, new pharmacologic agents are being approved for RA at a rapid pace, expanding the treatment options for this disease.

"Despite the many treatment recommendations included in this guideline, there are a number of remaining questions to address in more frequent, future updates. This guideline is a living document. As more therapies for RA emerge, we will modify what we recommend now," she says.

Recommendations were developed by panelists using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to assess available evidence from current scientific literature.

The manuscript, containing the full list of recommendations and supporting evidence, is currently under review and is anticipated to be simultaneously published in Arthritis Care & Research and Arthritis & Rheumatology by fall 2020, pending completion of peer review.


rheumatoid arthritisdisease-modifying anti-rheumatic drugsteroidsmethotrexatethe american college of rheumatologyManagement of rheumatoid arthritisNew guidelines
Source : ACR Convergence 2020
Hina Zahid
Hina Zahid

    Hina Zahid Joined Medical Dialogue in 2017 with a passion to work as a Reporter. She coordinates with various national and international journals and association and covers all the stories related to Medical guidelines, Medical Journals, rare medical surgeries as well as all the updates in the medical field. Email: editorial@medicaldialogues.in. Contact no. 011-43720751

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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