EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs

Treatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-à-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update

Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recommendations address conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GC); biological (b) DMARDs (tumour necrosis factor (TNF)-inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, clazakizumab, sarilumab and sirukumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (Janus kinase (Jak) inhibitors tofacitinib, baricitinib). Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. Cost aspects were taken into consideration. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at >50% improvement within 3 and target attainment within 6 months. If this fails stratification is recommended. Without unfavourable prognostic markers, switching to—or adding—another csDMARDs (plus short-term GC) is suggested. In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered. For each recommendation, levels of evidence and Task Force agreement are provided, both mostly very high. These recommendations intend informing rheumatologists, patients, national rheumatology societies, hospital officials, social security agencies and regulators about EULAR's most recent consensus on the management of RA, aimed at attaining best outcomes with current therapies

Perspectivism in Plato’s Views of the Gods

In the Sophist (235 c - 237 a), Plato presents a distinction between two kinds of mimetic art: “the art of likeness-making” (eikastikè technè), over against “the art of appearance-making” (fantastikè technè). The first consists in the accurate reproduction of the proportions of the model, while the second applies a number of tricks to remedy the optical effects brought about by the spectator’s perspective. Plato clearly prefers the image that accurately reproduces the proportions of the model, over the “perspectival” image, which –though more artistic – falls short in truth-value. This rejection of perspectivism is a major point in Plato’s aesthetics, ethics, and epistemology. But it also underlies Plato’s theology. Contrary to what recent interpreters have held, Plato’s theology is not about introducing a monistic system headed by a thinking (and hence, comprehensible) Nous. Rather, Plato’s view of the gods is based on accepting human beings’ incapacity to grasp the nature of the gods. Ultimately, “god is pre-eminently the ‘measure of all things’.” (Laws IV, 716 c-d). That leaves us again with the problem of “perspectivism”. Starting from Plato’s hesitation in speaking about the gods (e.g., Crat. 400 d - 401 a, and Phdr. 246 b-d), and on his rejection of the Homeric description of the gods (Rep. II), we shall discuss this rejection of perspectivism in the context of theology. This will also involve a discussion of “speaking about the gods” in the context of cosmology (e.g. the Demiurge in the Timaeus), and, in general, of Plato’s innovation (or lack of it) in theology

Le « service des dieux » chez Platon : Religion et moralité dans l’Euthyphron et les Lois

Dans l’adresse aux colons que l’on trouve au livre IV des Lois, l’Athénien institue ce qu’il appelle le « service des dieux » (therapeia theôn). Il s’agit là d’une description plutôt traditionnelle de pratiques religieuses et cultuelles. Pourtant, Platon y ajoute un élément essentiel, à savoir que les dieux n’acceptent que les sacrifices et les offrandes des hommes de bien, en refusant ceux des hommes méchants. Dans cette contribution, nous nous proposons de déceler le rôle que Platon attribu..

Bibliographie

I. Éditions du Phiilèbe Badham, C., The Philebus of Plato. With Introduction and Notes, London, 1855, 18782 (avec modifications). Burnet, J., Platonis Opera, 5 t., t. II, Oxford (Scriptorum classicorum bibliotheca Oxoniensis), 198818 (1901). Bury, R.G., The Philebus of Plato, Cambridge, 1988 (1897). Dewin, X., Plato. Verzameld werk, Antwerpen, 19803. Diès, A., Platon. Philèbe, Paris (Les Belles Lettres), 1941 (4e tirage 1966) : Tovar, A., in Emerita, 7 (1942), 174-175. Fowler, H.N., The Phile..

Le Philèbe dans l’interprétation de Jamblique

Jamblique occupe une position centrale dans l’élaboration des doctrines néoplatoniciennes. L’une des innovations qu’il a introduites est d’avoir attiré l’attention sur les dialogues platoniciens. Certes, l’exégèse de Platon avait été le but des Néoplatoniciens dès le départ, mais Jamblique y introduit une modification profonde. Désormais, le système philosophique sera présenté en premier lieu à partir d’une herméneutique philosophique des dialogues séparés. Jamblique exige que l’on respecte l..

Beauté, proportion et vérité comme «vestibule» du bien dans le «Philèbe»

In the Philebus beauty is combined with truth and proportion in order to constitute a triad which, the absolute good not being directly accessible, can help to assess the goodness of a mixture. The present article examines the mutual relation between the terms of the triad as well as between the triad and the good. The interpretation hinges on the distinction between the «order of the good» and the «order of nature» which is to be found in the Republic (493 c): art, which only has the intention to realize an appearance of beauty, is said to belong to the natural order (the object of which are the necessities and needs of nature, and also that which the artist conceives as the need of his audience). This conception of alleged beauty is contrasted with true beauty, which contains in itself truth and proportion, thus being an expression of the good.Dans le Philèbe la beauté s'associe à la vérité et à la proportion pour constituer une triade qui permet d'évaluer la bonté d'un mélange, le bien en soi étant inaccessible de façon directe. Le présent article examine les rapports entre les termes de la triade, tout comme entre la triade et le bien. L'interprétation pivote sur la distinction entre «l'ordre du bien» et «l'ordre naturel», telle qu'elle est présentée dans la République (493 c): l'art, qui se contente de réaliser une apparence de beauté, est dit relever de l'ordre naturel (ayant pour objet les nécessités et besoins de la nature, et de surcroît ce que l'artiste conçoit comme les exigences de son public). Cette conception de la beauté trompeuse est opposée à la vraie beauté qui comporte en soi la vérité et la proportion, et qui est dès lors une expression du bien.Van Riel Gerd. Beauté, proportion et vérité comme «vestibule» du bien dans le «Philèbe». In: Revue Philosophique de Louvain. Quatrième série, tome 97, n°2, 1999. pp. 253-267