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Joint Bone Spine. 2014 Jul;81(4):287-97. doi: 10.1016/j.jbspin.2014.05.002. Epub 2014 Jun 27.

Recommendations of the French Society for Rheumatology for managing rheumatoid arthritis.

Author information

1
Department of Rheumatology, Nîmes University Hospital, EA 2415, Montpellier I University, 30029 Nîmes, France. Electronic address: cecile.gaujoux.viala@chu-nimes.fr.
2
Sorbonne Universities, UPMC Univ Paris 06, GRC 08, institut Pierre Louis d'épidémiologie et de santé publique; AP-HP, Department of Rheumatology, CHU Pitié-Salpetrière, 75013 Paris, France.
3
Department of Rheumatology, Purpan Hospital, CHRU de Toulouse, Paul Sabatier Toulouse III University, UMR Inserm 1043-CNRS 5282, 31059 Toulouse, France.
4
Paris Descartes University - Department of Rheumatology -Cochin Hospital, Assistance Publique - Hôpitaux de Paris - INSERM (U1153): épidémiologie clinique et biostatistiques, PRES Sorbonne Paris-Cité, 75014 Paris, France.
5
Department of Rheumatology, Paris-Sud Universities Hospital, AP-HP, Inserm U 1012, Paris Sud University, 92276 Le Kremlin Bicêtre, France.
6
Cabinet de rhumatologie, 78200 Mantes la Jolie, Yvelines, France.
7
Department of rheumatology, CHU de la Cavale Blanche, boulevard Tanguy-Prigent, 29609 Brest, France; EA 2216, Bretagne Occidentale University, 29200 Brest, France.
8
Association nationale de défense contre l'arthrite rhumatoïde (ANDAR), 75014 Paris, France.
9
Department of rheumatology, Lapeyronie Hospital, CHRU de Montpellier, Montpellier I University, UMR 5535, 34295 Montpellier, France.

Abstract

INTRODUCTION:

This article reports the latest recommendations of the French Society for Rheumatology (SFR) regarding the management of rheumatoid arthritis (RA).

METHODS:

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.

RESULTS:

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.

CONCLUSION:

These recommendations are designed to improve the management of patients with RA.

KEYWORDS:

Biologics; Glucocorticoid therapy; Recommendations; Rheumatoid arthritis; Treatment

PMID:
24986683
DOI:
10.1016/j.jbspin.2014.05.002
[Indexed for MEDLINE]
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