ACR Set to Issue Updated Treatment Guidelines

The American College of Rheumatology is expected to issue updated treatment guidelines for rheumatoid arthritis no later than spring 2021. The new guidelines will include recommended uses for biologics approved since the last update in 2015―including JAK inhibitors.

Liana Fraenkel, M.D., MPH, an adjunct professor in the Division of Rheumatology, Allergy and Immunology at Yale University School of Medicine previewed the proposed guidelines at ACR’s annual meeting which wrapped this week.

The guidelines are now under peer review with anticipated simultaneous publication in Arthritis Care & Research and Arthritis & Rheumatology.

Dr. Fraenkel noted that, while prednisone will continue to maintain a role as a bridging treatment, ACR is hoping to move away from over-reliance on the use of steroids due to their significant side effects.

Continuing in the vein of expanded use of DMARDs, the updated guidelines will conditionally recommend that clinicians refrain from escalating patients to dual or triple therapy without first trying DMARD monotherapy.

The guidelines will also expand to cover detailed recommendations on drug tapering. And, they will address patients who are suffering from persistent hypogammaglobulinemia but do not have evidence of infection.

The updated guidelines were developed in concert with a large group of patients, clinicians, and researchers who conducted an extensive review of published medical literature.

The ACR panel invited physicians from outside of the rheumatology community to provide input on how to help manage RA complications in organ systems outside of those traditionally studied by rheumatologists.

Dr. Fraenkel said more updates will be issued beyond the RA guidelines in the coming year. “There are some other important topics that will not be covered in these guidelines… there will be guidelines forthcoming on non-pharmacological management of rheumatoid arthritis that we recognize as being extremely important, and the ACR will address vaccine recommendations in a document that will address other inflammatory diseases beyond rheumatoid arthritis given the commonalities associated across the various conditions,” she said.

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REFERENCE

Abstract 5MO18 “New Rheumatoid Arthritis Guideline Emphasizes Maximizing Methotrexate and Biologics, Minimizing Steroids.” The annual meeting of the American College of Rheumatology. 8:30 AM, Monday, Nov. 9, 2020