The State Environmental Expertise updates recommendations for the treatment of rheumatoid arthritis.

The Spanish Society of Rheumatology (SER) has updated its guidelines on the use of targeted biological and synthetic therapies in rheumatoid arthritis (RA). This edition replaces the previous one published in 2015. Therefore, provide a basis for the treatment of RA with this type of treatment using the latest available evidence. These developments are tailored to the specific needs of each patient, using new clinical situations, drugs and general principles “that were not envisaged in previous recommendations.”

The head of the rheumatology service at the Gregorio Marañón Hospital in Madrid, José María Álvaro-Gracia, detailed in an interview with Gaceta Médica that this update “involves shared decision-making between the patient and the rheumatologist when choosing the question: ‘What is the most appropriate therapy for each case?’” He also pointed out the importance of having “all the drugs approved to treat the disease”

This is because many patients, although initially responsive to therapy, may stop doing so over time.

Regarding specific recommendations, Alvaro-Gracia stressed that “Early treatment with disease-modifying drugs, primarily methotrexate, in all patients diagnosed with rheumatoid arthritis.” For those patients who do not respond to methotrexate, “better options are available, including biologic therapy and targeted therapy with Janus kinase (JAK) inhibitors.” For example, he noted that such treatments “are considered reasonable options,” limited to certain cases. These include “people with a history of tumors” or people with “increased risk of infections,” particularly those over 65 or with cardiovascular risk.

In addition, the SER provided clear recommendations on “what to do with those patients who stop responding to the first biological therapy strategy.” The goal is to analyze which options are most suitable according to the patient’s profile.as Alvaro-Gracia insisted. For this reason, recommendations were also included for patients in “special clinical situations,” such as those with “previous lung disease” or a “history of cancer.”

Impact on rheumatology

Regarding the impact of this update on the field of rheumatology, Alvaro-Gracia emphasized that it is “probably the most solid basis that will help rheumatologists in making therapeutic decisions for patients with rheumatoid arthritis.” Thus, he emphasized the complexity of this disease and the variety of therapeutic options available. This reason is considered “fundamental” for having clear recommendations based on rigorous evidence. The group of 13 experts who worked on these recommendations allowed us to “digest the complexity of these treatments and determine which treatment options are most appropriate based on the patient’s profile.”

Regarding future updates and advances in the treatment of rheumatoid arthritis, the head of the rheumatology service, Gregorio Marañon, was cautious in his predictions. “We must be very careful about how knowledge develops”was abundant. It thus emphasized the need to obtain more information on the “safety profile of these drugs” through new clinical trials and real-life studies. In addition, it emphasized that it was “aware of new advances in the discovery of new treatments.” This would allow new options to be included in future recommendations.

Updating a document

The update of the SER Consensus Statement on the Use of Targeted Biological and Synthetic Therapies in Rheumatoid Arthritis has been The main goal is to “support the physician in making therapeutic decisions”as compiled from it. A group of 13 experts selected at a public meeting of SER participated in this process. To do this, they used a mixed adaptation-development-update methodology based on the EULAR 2019, American College of Rheumatology 2021, and GUIPCAR 2017 guidelines.

As for the results, The group concluded that there were five general principles and 15 recommendations for the treatment of RA.. They cover aspects such as the “importance of early treatment”, the therapeutic goal or the “frequency of monitoring”. They also reviewed the use of glucocorticoids and the use of conventional, biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs). Recommendations for “dose reduction” in stable patients and the use of bDMARDs and JAK inhibitors in the above-mentioned special clinical situations are also included.

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