An Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis

Published by Dr Vanessa Glennon on Dec 8, 2021

Disclaimer

These clinical guidelines have been informed by the highest quality evidence available at the time of compilation. Accordingly, the parties involved in the development of these guidelines shall have no liability to any users of the information contained in this publication for any loss or damage, cost or expense incurred or arising from reliance on the information contained in this publication.
 

Sponsors

An Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis is being produced with assistance from the Australian Government’s Value in Prescribing (VIP) program grant, managed by the Targeted Therapies Alliance, a consortium coordinated by National Prescribing Service (NPS) MedicineWise. The program grant aims to improve the use of biological disease-modifying anti-rheumatic drugs (bDMARDs), using a variety of interventions and programs. The living guideline and living recommendations component is produced by the Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network, Australian Rheumatology Association (ARA), and Cochrane Musculoskeletal, in conjunction with the NPS MedicineWise consortium.

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Abstract

An Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis seeks to present the best available, current scientific evidence to assist decision making in the pharmacological management of the most common forms of IA, namely rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA).  The guideline offers recommended courses of action subject to clinical judgement and patient preferences.  Topics and questions identified as having highest clinical relevance to medical practitioners who treat IA are being prioritised. These questions include choice of DMARD, switching, combination therapy and down-titration of treatment, as well as the management of other medications such as opioids and vaccination.  As a living guideline, questions will continue to be addressed, new recommendations developed, and existing recommendations updated on an ongoing basis.

Language

en

PICOS

PICO 1.1

Population
Rheumatoid arthritis patients with low disease activity
Intervention
Dose reduction
Comparator
Continuation
Outcomes

PICO 1.1

Population
Adults with rheumatoid arthritis
Intervention
Opioids
Comparator
Placebo
Outcomes

PICO 1.1

Population
People with inflammatory rheumatic diseases on immunomodulatory therapies
Intervention
COVID vaccines (AstraZeneca, Pfizer and Moderna)
Comparator
Placebo
Outcomes

PICO 1.1

Population
Adults with rheumatoid arthritis experiencing disease flare, and receiving DMARD therapy
Intervention
Glucocorticoids
Comparator
No glucocorticoids
Outcomes

PICO 1.2

Population
Rheumatoid arthritis patients with low disease activity
Intervention
Discontinuation
Comparator
Continuation
Outcomes

PICO 1.2

Population
Adults with rheumatoid arthritis experiencing disease flare, and receiving DMARD therapy
Intervention
Glucocorticoid therapy (dexamethasone, DEXA i.v. infusion) as an adjunct to DMARD therapy
Comparator
Different glucocorticoid therapy (methylprednisolone, MP i.v. infusion) as an adjunct to DMARD therapy
Outcomes

PICO 2.1

Population
Axial spondyloarthritis patients with low disease activity
Intervention
Dose reduction
Comparator
Continuation
Outcomes

PICO 2.1

Population
Adults with axial spondyloarthritis
Intervention
Opioids
Comparator
Different opioids and analgesic comparators were used across the studies: Chang 2013 compared tramadol 37.5 mg/paracetamol 325 mg combination tablets (Ultracet®) one tablet twice a day, plus aceclofenac (NSAID) tablet per oral 100 mg twice a day with placebo plus 100 mg aceclofenac (NSAID) tablet per oral twice a day; Murphy 1978 compared dihydrocodeine tartrate (one 30mg tablet, DF-118®), taken 3-4 times daily for a period of 4 to 14 days with fenoprofen (one 200 mg capsule) and paracetamol (one 500 mg tablet), taken 3 to 4 times daily for a period of 4 to 14 days.
Outcomes

PICO 2.1

Population
People with inflammatory rheumatic diseases on immunomodulatory therapies
Intervention
COVID-19 third-dose vaccines (AstraZeneca, Pfizer and Moderna)
Comparator
Placebo
Outcomes

PICO 2.1

Population
Adults with rheumatoid arthritis receiving DMARD therapy
Intervention
Glucocorticoid (GC) therapy as an adjunct to DMARD therapy
Comparator
DMARD therapy alone (placebo or no GC)
Outcomes

PICO 2.2

Population
Axial spondyloarthritis patients with low disease activity
Intervention
Discontinuation
Comparator
Continuation
Outcomes

PICO 2.3

Population
Axial spondyloarthritis patients with low disease activity (Duplicate pending update)
Intervention
Discontinuation
Comparator
Continuation
Outcomes

PICO 3.1

Population
Psoriatic arthritis patients with low disease activity
Intervention
Dose reduction
Comparator
Continuation
Outcomes

PICO 3.1

Population
Adults with psoriatic arthritis
Intervention
Opioids
Comparator
Analgesics
Outcomes

PICO 3.2

Population
Psoriatic arthritis patients with low disease activity
Intervention
Discontinuation
Comparator
Continuation
Outcomes

PICO 8.1

Population
Adults with inflammatory arthritis receiving DMARD therapy prior to elective surgery
Intervention
Perioperative discontinuation of csDMARDs
Comparator
Continuation of csDMARDs
Outcomes