The American College of Rheumatology (ACR) shared the 2015 Guideline for the Treatment of Rheumatoid Arthritis this week during its annual meeting in San Francisco. Now available on the ACR website for patients to review, ACR invited Seth Ginsberg, president and co-founder of CreakyJoints and arthritis patient to join the evaluation panel in developing the clinical practice guidelines (CPGs). Ginsberg joined the clinician panel alongside another patient panelist to help be the voice for patients and the overall arthritis patient community.
“At CreakyJoints, our foundation is based on helping to offer the patient perspective when it comes to bettering the treatment of all forms of arthritis,” said Ginsberg. “And, we appreciate the inclusive environment the American College of Rheumatology provides by recognizing the importance of the patient perspective and incorporating it into its newly published guidelines. These CPGs impact how the condition is treated and insurance coverage, which ultimately affect the patient. It’s critical to understand patient preferences and priorities to help ensure access to the full range of treatment options.”
The guidelines are regularly updated and are referred to by rheumatologists and other healthcare professionals when determining treatment decisions they may commonly face or have to consider in patient care. The guideline panel meets to review and discuss several key hot topic areas and makes recommendations based on examining outcomes from the latest collection of clinical evidence.
Some of the recommendations in this year’s guidelines provide clarity on:
- Using DMARDs, biologics, tofacitinib and glucocorticoids in patients with early and established RA and the risks of biologics and DMARDs in high-risk RA patients who may have hepatitis, congestive heart failure, serious infections, etc.
- Guiding patients on tapering and discontinuing medications
- How best to provide vaccines for patients starting/receiving DMARDs or biologics
According to ACR, the guidelines provide recommendations that are classified as “strong” or “conditional.” Of the total recommendations made, the panel labeled 23 percent of them as strong, which means following those guidelines would lead to desirable effects for patients and physicians alike. The remaining 77 percent of guidelines fell into the conditional category, noting the course of action recommended would be in the best interest of most patients but some may not want to follow based on individual preferences.
Some of the strong recommendations included in this year’s guidelines are:
- For those with newly diagnosed RA whose disease activity is low and have not taken a DMARD, it is recommended to treat with a DMARD monotherapy (methotrexate is preferred) over multiple therapy.
- For those with established RA whose disease activity is moderate-to-high despite taking a DMARD, it is recommended to instead treat with a combination of traditional DMARDs or add a TNFi or a non-TNF biologic or tofacitinib.
Some of the conditional recommendations included in the guidelines are:
- For those with newly diagnosed RA whose disease activity is moderate-to-high and have not taken a DMARD, it is recommended to treat with a DMARD monotherapy over multiple therapy.
- For those with established RA whose disease activity is moderate-to-high and have never taken a DMARD, using a DMARD monotherapy (methotrexate is preferred) over togacitinib or a combination of DMARDs.
During the 2015 ACR meeting this week, the importance of the patient perspective has been a hot topic area of discussion. In timing with the meeting, a paper titled, “When patients write the guidelines: Patient panel recommendations for the treatment of rheumatoid arthritis,” was published in Arthritis Care & Research and highlighted study findings that showed patients can play a more meaningful and active role in the development of CPGs. In the study, several CreakyJoints members served on a full patient panel alongside a physician panel to examine clinical evidence and provide recommendations on RA treatment guidelines. The study found patients and physicians came to nearly the same recommendations for patients in terms of overall care but had noteworthy differences in terms of the impact of side effects when examining various treatment scenarios—making the patient perspective important to consider.
To help physicians and patients keep up with the 2015 guidelines, the ACR plans to develop a pocket card, an app version of the guideline and a patient education tool to facilitate implementation.
To read the guideline in its entirety, please click here.