MONDAY, Nov. 16, 2020 — The American College of Rheumatology (ACR) previewed its 2020 Guideline for the Management of Rheumatoid Arthritis (RA) at ACR Convergence, the College’s annual meeting, held virtually from Nov. 5 to 9.

Panelists, including rheumatologists, methodologists, and patients living with the disease, developed the recommendations using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology to assess the current scientific literature. The full list of drug treatment-related recommendations and supporting evidence is currently under peer review, with anticipated publication soon.

The recommendations emphasize starting patients on methotrexate and continuing with the treatment instead of rapidly switching to another disease-modifying antirheumatic drug. Due to serious side effects, new recommendations minimize the use of glucocorticoids, or steroids, to treat RA inflammation. Escalation to triple therapy before starting a biologic is no longer recommended. Additionally, there are specific recommendations on drug tapering and treatment of patient populations not covered in previous guidelines, including those with subcutaneous nodules, pulmonary disease, nonalcoholic fatty liver disease, persistent hypogammaglobulinemia, and nontuberculous mycobacterial lung disease.

“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,” Liana Fraenkel, M.D., from the Yale University School of Medicine in New Haven, Connecticut, said in a statement.

2020 ACR Guideline for the Management of Rheumatoid Arthritis

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