Turkish League Against Rheumatism (TLAR) Recommendations for the Pharmacological Management of Rheumatoid Arthritis: 2018 Update Under Guidance of Current Recommendations

Şebnem ATAMAN1, İsmihan SUNAR1, Gürkan YILMAZ1, Hatice BODUR2, Kemal NAS3, Fikriye Figen AYHAN4,5, Özgür AKGÜL6, Ayşen AKINCI7, Zuhal ALTAY8, Murat BİRTANE9, Derya SOY BUĞDAYCI10, Erhan ÇAPKIN11, Remzi ÇEVİK12, Yeşim GARİP ÇİMEN13, M. Tuncay DURUÖZ14, Atilla Halil ELHAN15, Gülcan GÜRER16, Cahit KAÇAR17, Ayhan KAMANLI3, Ece KAPTANOĞLU18, Taciser KAYA19, Hilal KOCABAŞ20, Ömer KURU21, Meltem ALKAN MELİKOĞLU22, Sumru ÖZEL23, Aylin REZVANİ24, İlhan SEZER25, Fatma Gül YURDAKUL13

1Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Ankara University School of Medicine, Ankara, Turkey
2Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
3Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Sakarya University School of Medicine, Sakarya, Turkey
4Department of Physical Medicine and Rehabilitation, Uşak University, High School of Health Sciences, Uşak, Turkey
5Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Ankara Training and Research Hospital, Ankara, Turkey
6Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Celal Bayar University School of Medicine, Manisa, Turkey
7Department of Physical Medicine and Rehabilitation, Hacettepe University School of Medicine, Ankara, Turkey
8Department of Physical Medicine and Rehabilitation, İnönü University School of Medicine, Malatya, Turkey
9Department of Physical Medicine and Rehabilitation, Trakya University School of Medicine, Edirne, Turkey
10Department of Physical Medicine and Rehabilitation, İstanbul Training and Research Hospital, İstanbul, Turkey
11Department of Physical Medicine and Rehabilitation, Karadeniz Technical University School of Medicine, Trabzon, Turkey
12Department of Physical Medicine and Rehabilitation, Dicle University School of Medicine, Diyarbakır, Turkey
13Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Numune Training and Research Hospital, Ankara, Turkey
14Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University School of Medicine, İstanbul, Turkey
15Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
16Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Adnan Menderes University School of Medicine, Aydın, Turkey
17Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey
18Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Cumhuriyet University School of Medicine, Sivas, Turkey
19Department of Physical Medicine and Rehabilitation, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
20Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
21Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
22Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Atatürk University School of Medicine, Erzurum, Turkey
23Department of Physical Medicine and Rehabilitation, Hitit University School of Medicine, Çorum, Turkey
24Department of Physical Medicine and Rehabilitation, Bezmiâlem Foundation University, İstanbul, Turkey
25Department of Physical Medicine and Rehabilitation, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey

Keywords: Disease modifying anti-rheumatic drugs, management, rheumatoid arthritis, treatment recommendations, Turkish League Against Rheumatism

Abstract

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.

Citation: Ataman Ş, Sunar İ, Yılmaz G, Bodur H, Nas K, Ayhan FF, et al. Turkish League Against Rheumatism (TLAR) Recommendations for the Pharmacological Management of Rheumatoid Arthritis: 2018 Update Under Guidance of Current Recommendations. Arch Rheumatol 2018;33(3):251-272.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.