2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis

Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are applicable for people with inflammatory arthritis (iA; Rheumatoid Arthritis and Spondyloarthritis) and osteoarthritis (hip/knee OA) in order to develop evidence-based recommendations for advice and guidance on PA in clinical practice. The EULAR standardised operating procedures for the development of recommendations were followed. A task force (TF) (including rheumatologists, other medical specialists and physicians, health professionals, patient-representatives, methodologists) from 16 countries met twice. In the first TF meeting, 13 research questions to support a systematic literature review (SLR) were identified and defined. In the second meeting, the SLR evidence was presented and discussed before the recommendations, research agenda and education agenda were formulated. The TF developed and agreed on four overarching principles and 10 recommendations for PA in people with iA and OA. The mean level of agreement between the TF members ranged between 9.8 and 8.8. Given the evidence for its effectiveness, feasibility and safety, PA is advocated as integral part of standard care throughout the course of these diseases. Finally, the TF agreed on related research and education agendas. Evidence and expert opinion inform these recommendations to provide guidance in the development, conduct and evaluation of PA-interventions and promotion in people with iA and OA. It is advised that these recommendations should be implemented considering individual needs and national health systems.EULA

Turkish League Against Rheumatism (Tlar) Recommendations For The Pharmacological Management Of Rheumatoid Arthritis: 2018 Update Under Guidance Of Current Recommendations

Objectives: This study aims to report the assessment of the Turkish League Against Rheumatism (TLAR) expert panel on the compliance and adaptation of the European League Against Rheumatism (EULAR) 2016 recommendations for the management of rheumatoid arthritis (RA) in Turkey. Patients and methods: The EULAR 2016 recommendations for the treatment of RA were voted by 27 specialists experienced in this field with regard to participation rate for each recommendation and significance of items. Afterwards, each recommendation was brought forward for discussion and any alteration gaining >= 70% approval was accepted. Also, Turkish version of each item was rearranged. Last version of the recommendations was then revoted to determine the level of agreement. Levels of agreement of the two voting rounds were compared with Wilcoxon signed-rank test. In case of significant difference, the item with higher level of agreement was accepted. In case of no difference, the changed item was selected. Results: Four overarching principles and 12 recommendations were assessed among which three overarching principles and one recommendation were changed. The changed overarching principles emphasized the importance of physical medicine and rehabilitation specialists as well as rheumatologists for the care of RA patients in Turkey. An alteration was made in the eighth recommendation on treatment of active RA patients with unfavorable prognostic indicators after failure of three conventional disease modifying anti-rheumatic drugs. Remaining principles were accepted as the same although some alterations were suggested but could not find adequate support to reach significance. Conclusion: Expert opinion of the TLAR for the treatment of RA was composed for practices in Turkish rheumatology and/or physical medicine and rehabilitation clinics.WoSScopu

Turkish League Against Rheumatism (Tlar) Recommendations For The Pharmacological Management Of Rheumatoid Arthritis: 2018 Update Under Guidance Of Current Recommendations

Objectives: This study aims to report the assessment of the Turkish League Against Rheumatism (TLAR) expert panel on the compliance and adaptation of the European League Against Rheumatism (EULAR) 2016 recommendations for the management of rheumatoid arthritis (RA) in Turkey. Patients and methods: The EULAR 2016 recommendations for the treatment of RA were voted by 27 specialists experienced in this field with regard to participation rate for each recommendation and significance of items. Afterwards, each recommendation was brought forward for discussion and any alteration gaining >= 70% approval was accepted. Also, Turkish version of each item was rearranged. Last version of the recommendations was then revoted to determine the level of agreement. Levels of agreement of the two voting rounds were compared with Wilcoxon signed-rank test. In case of significant difference, the item with higher level of agreement was accepted. In case of no difference, the changed item was selected. Results: Four overarching principles and 12 recommendations were assessed among which three overarching principles and one recommendation were changed. The changed overarching principles emphasized the importance of physical medicine and rehabilitation specialists as well as rheumatologists for the care of RA patients in Turkey. An alteration was made in the eighth recommendation on treatment of active RA patients with unfavorable prognostic indicators after failure of three conventional disease modifying anti-rheumatic drugs. Remaining principles were accepted as the same although some alterations were suggested but could not find adequate support to reach significance. Conclusion: Expert opinion of the TLAR for the treatment of RA was composed for practices in Turkish rheumatology and/or physical medicine and rehabilitation clinics.WoSScopu

Translation and cross-cultural adaptation of the ASAS Health Index and the environmental Item Set into 15 languages

Pathophysiology and treatment of rheumatic disease

Is There A Role For Tnf-α Antagonists In The Treatment Of Ssc? Eustar Expert Consensus Development Using The Delphi Technique

Objective: To obtain experiences and expert opinion on treatment of SSc patients with TNF-α antagonists. Methods: An investigation was carried out among the EUSTAR centres into their expertise on use of TNF-α antagonists. Assessment forms on the frequency of TNF-α inhibitor use were distributed to EULAR Scleroderma Trials and Research Group (EUSTAR) centres. Afterwards, a three round Delphi exercise was performed to obtain expert consensus on the use of TNF-α inhibitors in SSc. Results: Seventy-nine centres returned information on use of TNF-α antagonists in SSc patients. A total of 65 patients were treated with TNF-a inhibitors in 14 different centres. Forty-eight of the 65 patients treated with TNF-α inhibitors improved. Improvement was mainly seen in patients with arthritis, whereas the effects on fibrosis varied. In the first round of the subsequent Delphi approach, 71 out of 79 experts stated that they would use TNF-α antagonists in SSc. Arthritis was suggested as an indication for TNFa antagonists by 75% of the experts. However, after the third stage of the Delphi exercise, the acceptance for the off-label use of TNF-a antagonists decreased and 59% recommended that TNF-α antagonists should not be used or only used in clinical trials in SSc patients, while 38% of the experts suggested the use of TNF-a antagonists for arthritis associated with SSc. Conclusions: Most of the experts do not recommend the routine use of TNF-a antagonists in systemic sclerosis. 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I), p. 229Lam, G.K., Hummers, L.K., Woods, A., Wigley, F.M., Efficacy and safety of etanercept in the treatment of scleroderma-associated joint disease (2007) J Rheumatol, 34, pp. 1636-1637. , JulAlexis, A.F., Strober, B.E., Off-label dermatologic uses of anti-TNF-α therapies (2005) J Cutan Med Surg, 9, pp. 296-302Avouac, J., Walker, U., Tyndall, A., Characteristics of joint involvement and relationships with systemic inflammation in systemic sclerosis: Results from the EULAR Scleroderma Trial and Research Group (EUSTAR) database (2010) J Rheumatol, 37, pp. 1488-1501Khanna, D., Agrawal, H., Clements, P.J., Infliximab may be effective in the treatment of steroid-resistant eosinophilic fasciitis: Report of three cases (2010) Rheumatology, 49, pp. 1184-1188. , OxfordTzaribachev, N., Holzer, U., Schedel, J., Maier, V., Klein, R., Kuemmerle-Deschner, J., Infliximab effective in steroid-dependent juvenile eosinophilic fasciitis (2008) Rheumatology, 47, pp. 930-932. , OxfordAllanore, Y., Devos-Francois, G., Caramella, C., Boumler, P., Jounieaux, V., Kahan, A., Fatal exacerbation of fibrosing alveolitis associated with systemic sclerosis in a patient treated with adalimumab (2006) Ann Rheum Dis, 65, pp. 834-835Marie, I., Lahaxe, L., Levesque, H., Hellot, P., Pulmonary actinomycosis in a patient with diffuse systemic sclerosis treated with infliximab (2008) QJM, 101, pp. 419-421Ostor, A.J., Crisp, A.J., Somerville, M.F., Scott, D.G., Fatal exacerbation of rheumatoid arthritis associated fibrosing alveolitis in patients given infliximab (2004) BMJ, 329, p. 1266Amjadi, S., Maranian, P., Furst, D.E., Course of the modified Rodnan skin thickness score in systemic sclerosis clinical trials: Analysis of three large multicentre, double-blind, randomized controlled trials (2009) Arthritis Rheum, 60, pp. 2490-2498Denton, C.P., Merkel, P.A., Furst, D.E., Recombinant human anti-transforming growth factor beta1 antibody therapy in systemic sclerosis: A multicenter, randomized, placebo-controlled phase I/II trial of CAT-192 (2007) Arthritis Rheum, 56, pp. 323-333Kaldas, M., Khanna, P.P., Furst, D.E., Sensitivity to change of the modified Rodnan skin score in diffuse systemic sclerosis-assessment of individual body sites in two large randomized controlled trials (2009) Rheumatology, 48, pp. 1143-1146. , OxfordPostlethwaite, A.E., Wong, W.K., Clements, P., A multicenter, randomized, double-blind, placebo-controlled trial of oral type I collagen treatment in patients with diffuse cutaneous systemic sclerosis: I. Oral type I collagen does not improve skin in all patients, but may improve skin in late-phase disease (2008) Arthritis Rheum, 58, pp. 1810-1822Walker, U.A., Tyndall, A., Czirjak, L., Clinical risk assessment of organ manifestations in systemic sclerosis: A report from the EULAR Scleroderma Trials and Research group database (2007) Ann Rheum Dis, 66, pp. 754-763Linstone, H., Turoff, M., (2002) The Delphi Method. Techniques and Applications, , New Jersey Institute of Technology, California, USAJones, J., Hunter, D., Consensus methods for medical and health services research (1995) BMJ, 311, pp. 376-380Generini, S., Steiner, G., Miniati, I., Anti-hnRNP and other autoantibodies in systemic sclerosis with joint involvement (2009) Rheumatology, 48, pp. 920-925. , OxfordMatucci-Cerinic, M., Allanore, Y., Czirjak, L., The challenge of early systemic sclerosis for the EULAR Scleroderma Trial and Research group (EUSTAR) community. It is time to cut the Gordian knot and develop a prevention or rescue strategy (2009) Ann Rheum Dis, 68, pp. 1377-138