OP0008 EULAR EVIDENCE BASED RECOMMENDATIONS FOR THE MANAGEMENT OF EARLY RHEUMATOID ARTHRITIS
B. Combe, R. Landewe, C. Lukas, H. D. Bolosiu, F. Breedveld, M. Dougados, P. Emery, G. Ferraccioli, J. M. W. Hazes, L. Klareskog, K. Machold, E. Martin-Mola, H. Nielsen13, A. Silman, J. Smolen, H. Yazici

A group of 16 rheumatologists systematically set out to establish evidence based recommendations for the management of early RA. The focus was on early undifferentiated arthritis with a certain propensity to become persistent and erosive RA.

Through three Delphi rounds, 15 research questions were generated. Evidence for each was then evaluated and scored. Key recommendations for early arthritis/RA management based on group consensus were developed.

Summary of recommendations:

• Early referral to rheumatologist for more than 1 swollen/tender joints
• Workup should include careful exam and ESR, anti-CCP ab, RF and XR of hands
• The main goal of therapy is remission
• Methotrexate is the anchor DMARD
• Assess disease activity every 1-3 months, XR every 6-12 months
• Patients at risk of developing persistent or erosive disease should be started on a DMARD as soon as possible
• The use of 2 DMARDS has better outcome
• If remission is not achieved on combination DMARDS, then more intensive therapy should be started

Editorial Comment: These recommendations are result of the tremendous number of studies showing the benefit of early aggressive therapy. In these recommendations, remission is not formally defined and further work needs to be done. However, this is a very good beginning.

All information contained within the Johns Hopkins Arthritis Center website is intended for educational purposes only. Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.