Turkish Compliance and Adaptation of EULAR 2013 Recommendations for the Management of Rheumatoid Arthritis with Synthetic and Biological Disease-Modifying Antirheumatic Drugs: Expert Opinion of TLAR

摘要

Objectives: This study aims to report Turkish League Against Rheumatism’s assessment on the compliance of European League Against Rheumatism2013 treatment recommendations for rheumatoid arthritis with practices in Turkish rheumatology clinics and adaptations for Turkey.Materials and methods: Members of Turkish League Against Rheumatism and one rheumatoid arthritis patient voted for the 2013 recommendationsof the European League Against Rheumatism for treatment of rheumatoid arthritis in two sessions. An item was changed and voted again only ifat least 70% of participants wanted a change. Strength of recommendations was calculated for the items. Strength of recommendations for thechanged items in the first and second voting rounds was compared by Wilcoxon signed-rank test. In case of significant difference, the item withhigher strength of recommendation was accepted. In case of no difference, the changed item was selected.Results: Three overarching principles and fourteen recommendations were assessed among which the three overarching principles were changedemphasizing the importance of physiatrists as well as rheumatologists for taking care of the patients. Third item was changed by adding compositeindices for assessing disease activity. In the ninth recommendation, rituximab was suggested as a first line drug independent of situations like latenttuberculosis or lymphoma, etc. In the 11th recommendation, unlike European League Against Rheumatism, our committee did not suggest anythought about tofacitinib, as then it had not been approved in Turkey. Remaining principles were accepted as the same.Conclusion: Expert opinion of Turkish League Against Rheumatism for treatment of rheumatoid arthritis patients was formed for practices in Turkishclinics.