Elsevier

Joint Bone Spine

Volume 81, Issue 4, July 2014, Pages 287-297
Joint Bone Spine

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

https://doi.org/10.1016/j.jbspin.2014.05.002Get rights and content
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open access

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

Rheumatoid arthritis
Recommendations
Treatment
Biologics
Glucocorticoid therapy

Cited by (0)

1

The first two authors contributed equally to this work.