Update of EULAR recommendations for the treatment of systemic sclerosis
Top Cited Papers
Open Access
- 9 November 2016
- journal article
- review article
- Published by BMJ in Annals Of The Rheumatic Diseases
- Vol. 76 (8), 1327-1339
- https://doi.org/10.1136/annrheumdis-2016-209909
Abstract
The aim was to update the 2009 European League against Rheumatism (EULAR) recommendations for the treatment of systemic sclerosis (SSc), with attention to new therapeutic questions. Update of the previous treatment recommendations was performed according to EULAR standard operating procedures. The task force consisted of 32 SSc clinical experts from Europe and the USA, 2 patients nominated by the pan-European patient association for SSc (Federation of European Scleroderma Associations (FESCA)), a clinical epidemiologist and 2 research fellows. All centres from the EULAR Scleroderma Trials and Research group were invited to submit and select clinical questions concerning SSc treatment using a Delphi approach. Accordingly, 46 clinical questions addressing 26 different interventions were selected for systematic literature review. The new recommendations were based on the available evidence and developed in a consensus meeting with clinical experts and patients. The procedure resulted in 16 recommendations being developed (instead of 14 in 2009) that address treatment of several SSc-related organ complications: Raynaud's phenomenon (RP), digital ulcers (DUs), pulmonary arterial hypertension (PAH), skin and lung disease, scleroderma renal crisis and gastrointestinal involvement. Compared with the 2009 recommendations, the 2016 recommendations include phosphodiesterase type 5 (PDE-5) inhibitors for the treatment of SSc-related RP and DUs, riociguat, new aspects for endothelin receptor antagonists, prostacyclin analogues and PDE-5 inhibitors for SSc-related PAH. New recommendations regarding the use of fluoxetine for SSc-related RP and haematopoietic stem cell transplantation for selected patients with rapidly progressive SSc were also added. In addition, several comments regarding other treatments addressed in clinical questions and suggestions for the SSc research agenda were formulated. These updated data-derived and consensus-derived recommendations will help rheumatologists to manage patients with SSc in an evidence-based way. These recommendations also give directions for future clinical research in SSc.Keywords
This publication has 84 references indexed in Scilit:
- 2014 Update of the EULAR standardised operating procedures for EULAR-endorsed recommendationsAnnals Of The Rheumatic Diseases, 2014
- GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tablesJournal of Clinical Epidemiology, 2011
- Expert Agreement on EULAR/EUSTAR Recommendations for the Management of Systemic Sclerosis: Table 1.The Journal of Rheumatology, 2011
- EULAR recommendations for the treatment of systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group (EUSTAR)Annals Of The Rheumatic Diseases, 2009
- European League Against Rheumatism (EULAR) Scleroderma Trial and Research group (EUSTAR) recommendations for the treatment of systemic sclerosis: methods of elaboration and results of systematic literature researchAnnals Of The Rheumatic Diseases, 2008
- EULAR standardised operating procedures for the elaboration, evaluation, dissemination, and implementation of recommendations endorsed by the EULAR standing committeesAnnals Of The Rheumatic Diseases, 2004
- Calcium-channel blockers for Raynaud's phenomenon in systemic sclerosisArthritis & Rheumatism, 2001
- Nicardipine in the Treatment of Raynaud's Phenomenon: A Randomized Double-Blind TrialAngiology, 1987
- Controlled double-blind trial of dazoxiben and nifedipine in the treatment of Raynaud's phenomenonAmerican Journal Of Medicine, 1984
- Calcium entry blocking agents in digital vasospasm (Raynaud's phenomenon)European Heart Journal, 1983