What are the EULAR (European League Against Rheumatism) guidelines?

From the Guidelines

The EULAR guidelines are comprehensive recommendations developed by the European League Against Rheumatism for the diagnosis, management, and treatment of various rheumatic diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, systemic lupus erythematosus, and other inflammatory rheumatic diseases. These guidelines cover a wide range of conditions and provide evidence-based recommendations for optimal patient care.

Key Recommendations

• For rheumatoid arthritis, EULAR recommends early diagnosis and treatment with disease-modifying antirheumatic drugs (DMARDs), typically starting with methotrexate at 15-25 mg weekly as first-line therapy 1.
• The guidelines advocate for a treat-to-target approach aiming for remission or low disease activity, with regular monitoring using validated disease activity measures.
• If methotrexate is insufficient, combination therapy with conventional synthetic DMARDs or addition of a biological DMARD (such as TNF inhibitors, IL-6 inhibitors, or JAK inhibitors) is recommended.
• For psoriatic arthritis, the guidelines suggest NSAIDs for mild symptoms, followed by conventional DMARDs like methotrexate (15-25 mg weekly) for persistent disease, and biological therapies for inadequate response.

Disease Management

• EULAR guidelines are regularly updated based on emerging evidence and expert consensus to provide clinicians with practical, evidence-based recommendations for optimal patient care.
• The guidelines emphasize early intervention, personalized treatment approaches, and multidisciplinary care to improve long-term outcomes and quality of life for patients with rheumatic diseases.
• The management of rheumatic diseases should include more than drug treatment alone, with education, shared decision making, and the role of allied healthcare professionals as important themes 1.

Cardiovascular Risk Management

• Patients with rheumatoid arthritis and other inflammatory joint disorders have increased cardiovascular disease (CVD) risk compared with the general population 1.
• The EULAR task force recommends screening, identification of CVD risk factors, and CVD risk management largely based on expert opinion.

Gout Management

• For the treatment of flare, colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), oral or intra-articular steroids or a combination are recommended 1.
• In patients with frequent flare and contraindications to colchicine, NSAIDs and corticosteroids, an interleukin-1 blocker should be considered.

From the Research

Overview of EULAR Guidelines

• The European League Against Rheumatism (EULAR) guidelines provide recommendations for the management of rheumatoid arthritis (RA) and other rheumatic diseases.
• These guidelines are based on systematic literature reviews and expert consensus, and are updated regularly to reflect new evidence and developments in the field 2, 3.

Recommendations for Rheumatoid Arthritis Management

• The EULAR guidelines recommend methotrexate as the standard treatment option at the time of diagnosis, preferably in combination with low-dose glucocorticoids 2.
• Combined disease-modifying antirheumatic drugs (DMARD) therapy should be considered in patients not responding within 12 weeks 2.
• Treatment with biologicals should be initiated in patients with persistent high activity no later than 6 months after conventional treatment, and in exceptional situations even earlier 2.
• The guidelines also provide recommendations for the use of conventional synthetic DMARDs, glucocorticoids, biological DMARDs, and targeted synthetic DMARDs, as well as guidance on monotherapy, combination therapy, treatment strategies, and tapering in sustained clinical remission 3.

Treatment Strategies and Safety Considerations

• The EULAR guidelines emphasize the importance of a treat-to-target approach, with the goal of achieving remission or low disease activity 3.
• Safety aspects, including the risk of major cardiovascular events and malignancies, are also considered in the guidelines, and recommendations are provided for minimizing these risks 3.
• The guidelines also discuss the use of DMARDs, glucocorticoids, and biological agents in the treatment of RA, and provide guidance on sequencing and combination therapy 4.

Other Rheumatic Diseases

• The EULAR guidelines also provide recommendations for the management of other rheumatic diseases, such as ankylosing spondylitis 5.
• These guidelines emphasize the importance of nonsteroidal anti-inflammatory drugs (NSAIDs) in reducing pain and stiffness, and provide recommendations for the use of disease-modifying antirheumatic drugs (DMARDs) and other treatments in patients with ankylosing spondylitis 5.