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
Şebnem ATAMAN1, Zühre SARI SÜRMELİ1, İsmihan SUNAR1, Erhan ÖZDEMİREL1, Ayşen AKINCI5, Hatice BODUR2, Özgür AKGÜL3, Lale ALTAN4, Zuhal ALTAY6, Figen AYHAN7, Murat BİRTANE8, Derya SOY BUĞDAYCI9, Erhan ÇAPKIN10, Lale CERRAHOĞLU3, Mehmet Tuncay DURUÖZ11, Rezzan GÜNAYDIN12, Zafer GÜNENDİ13, Gülcan GÜRER14, Ajda BAL15, Cahit KAÇAR16, Ece KAPTANOĞLU17, Taciser KAYA18, Hilal KOCABAŞ19, Nurdan KOTEVOĞLU20, Kemal NAS21, Aylin REZVANİ22, Nesrin ŞEN23, Ömer Faruk ŞENDUR14, Peyman YALÇIN1
1Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Division of Rheumatology, Ankara, Turkey
2Department of Physical Medicine and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
3Department of Physical Medicine and Rehabilitation, Medical Faculty of Celal Bayar University, Manisa, Turkey
4Department of Physical Medicine and Rehabilitation, Medical Faculty of Uludag University, Bursa, Turkey
5Department of Physical Medicine and Rehabilitation, Medical Faculty of Hacettepe University, Ankara, Turkey
6Department of Physical Medicine and Rehabilitation, Medical Faculty of İnönü University, Malatya, Turkey
7Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
8Department of Physical Medicine and Rehabilitation, Medical Faculty of Trakya University, Edirne, Turkey
9Department of Physical Medicine and Rehabilitation, İstanbul Physical Medicine and Rehabilitation Training and Research Hospital, İstanbul, Turkey
10Department of Physical Medicine and Rehabilitation, Medical Faculty of Karadeniz Technical University, Trabzon, Turkey
11Department of Physical Medicine and Rehabilitation, Medical Faculty of Marmara University, İstanbul, Turkey
12Department of Physical Medicine and Rehabilitation, Medical Faculty of Ordu University, Ordu, Turkey
13Department of Physical Medicine and Rehabilitation, Medical Faculty of Gazi University, Ankara, Turkey
14Department of Physical Medicine and Rehabilitation, Medical Faculty of Adnan Menderes University, Aydın, Turkey
15Department of Physical Medicine and Rehabilitation, Dışkapı Training and Research Hospital, Ankara, Turkey
16Department of Physical Medicine and Rehabilitation, Medical Faculty of Akdeniz University, Antalya, Turkey
17Department of Physical Medicine and Rehabilitation, Medical Faculty of Cumhuriyet University, Sivas, Turkey
18Department of Physical Medicine and Rehabilitation, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
19Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
20Department of Physical Medicine and Rehabilitation, Medical Faculty of Maltepe University, İstanbul, Turkey
21Department of Physical Medicine and Rehabilitation, Medical Faculty of Sakarya University, Adapazarı, Turkey
22Department of Physical Medicine and Rehabilitation, Medical Faculty of Bezmialem Vakıf University, İstanbul, Turkey
23Department of Physical Medicine and Rehabilitation, Elazığ Training and Research Hospital, Elazığ, Turkey
Keywords: Biologic disease modifying anti-rheumatic drugs, rheumatoid arthritis, synthetic disease modifying anti-rheumatic drugs, treatment recommendations
Abstract
Objectives: This study aims to report Turkish League Against Rheumatism’s assessment on the compliance of European League Against Rheumatism 2013 treatment recommendations for rheumatoid arthritis with practices in Turkish rheumatology clinics and adaptations for Turkey.
Patients and methods: Members of Turkish League Against Rheumatism and one rheumatoid arthritis patient voted for the 2013 recommendations of the European League Against Rheumatism for treatment of rheumatoid arthritis in two sessions. An item was changed and voted again only if at least 70% of participants wanted a change. Strength of recommendations was calculated for the items. Strength of recommendations for the changed items in the first and second voting rounds was compared by Wilcoxon signed-rank test. In case of significant difference, the item with higher 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 changed emphasizing the importance of physiatrists as well as rheumatologists for taking care of the patients. Third item was changed by adding composite indices for assessing disease activity. In the ninth recommendation, rituximab was suggested as a first line drug independent of situations like latent tuberculosis or lymphoma, etc. In the 11th recommendation, unlike European League Against Rheumatism, our committee did not suggest any thought 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 Turkish clinics.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.