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Pharmaceutical Guidelines for RA “Vague”

January 10, 2017

The authors of a recent systematic literature review reported suboptimal recommendations regarding glucocorticoid (GC) use for rheumatoid arthritis (RA) management among current RA pharmacologic treatment guidelines.

“All guidelines agree that GC, especially if given at low dosages and for a short duration, are an appropriate option in the treatment of RA,” the authors write in the study. “However, many recommendations remain vague as reliable and detailed evidence is scarce.”


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RA is a common, chronic autoimmune disorder affecting more than 1.3 million people in the United States. Symptoms include joint stiffness, pain, and swelling. Patients also experience limited joint function. Hand and foot joints are most often affected in RA.

Researchers from Germany, Austria, The Netherlands, and the United States used PubMed, EMBASE, and Cochrane databases to find articles on RA treatment. They evaluated the quality of the articles with the AGREE (Appraisal of Guidelines for REsearch & Evaluation) II instrument.

Findings revealed that the guidelines either partially or completely left out important details of GC therapy and used inconsistent nomenclature. Further, flaws relating to both GC recommendations and guideline quality were also observed among the articles.

The authors call for “more rigorous evaluation” of GC dosages, timing, and duration of their use and also note the importance of using uniform nomenclature for GC therapy.--Meredith Edwards White


Palmowski Y, Buttgereit T, Dejaco C, et al. The "official view" on glucocorticoids in rheumatoid arthritis. A systematic review of international guidelines and consensus statements [Published online ahead of print December 28, 2016]. Arthritis Care Res (Hoboken). doi: 10.1002/acr.23185.

Ruderman, E, Tambar S. Rheumatoid Arthritis. American College of Rheumatology website. Update August 2013. Accessed January 10, 2017.

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