The speakers described how this recommendation is meant to encourage rheumatologists to limit the use of steroids as much as possible given the potential harms associated with this medication class. The members of the guideline committee noted that glucocorticoid use is appropriate to help patients with acutely active RA. However, minimizing steroid use to periods when such treatment is absolutely needed is the ideal path for rheumatologists to follow.
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As part of the panel discussion, the subject of tapering medications arose, and the speakers provided helpful insight into the topic. Often when patients feel better with regard to their RA symptoms, they ask their rheumatologist if and when they can taper their medications to avoid potential side effects, save time and money with respect to treatment, and achieve other potential benefits.
For this draft guideline, a discussion of tapering was recommended only if a patient has achieved target disease control for at least six months. At that point, it would be reasonable for the rheumatologist to discuss tapering medications with the patient, while including a full and informed discourse about the potential for flares. Back-up plans for situations in which disease activity increases should also be addressed.
Finally, Bryant England, MD, PhD, assistant professor of internal medicine in the Division of Rheumatology, University of Nebraska Medical Center, Omaha, noted the committee has provided a roadmap for how the field of rheumatology can and should seek to answer the pressing research questions of our era.
By specifically working on the most clinically challenging and relevant issues, researchers can provide the data that will allow recommendations in future guideline documents to be made with strong evidentiary support. This approach will, in turn, help clinicians, who will be able to refer to robust data and recommendations to support what they do in clinical practice.
Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.
- Hunter TM, Boytsov NN, Zhang X, et al. Prevalence of rheumatoid arthritis in the United States adult population in healthcare claims databases, 2004–2014. Rheumatol Int. 2017 Sep;37(9):1551–1557.
- O’Dell JR, Mikuls TR, Taylor TH, et al. Therapies for active rheumatoid arthritis after methotrexate failure. N Engl J Med. 2013 Jul 25;369(4):307–318.