Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Clinical Rheumatology
Published in: Clinical Rheumatology 3/2011

Open Access 01-03-2011 | Review Article

Management of rheumatoid arthritis: consensus recommendations from the Hong Kong Society of Rheumatology

Authors: Chi Chiu Mok, Lai Shan Tam, Tak Hin Chan, Gavin K. W. Lee, Edmund K. M. Li, Hong Kong Society of Rheumatology

Published in: Clinical Rheumatology | Issue 3/2011

Login to get access

Abstract

Given the recent availability of novel biologic agents for the treatment of rheumatoid arthritis (RA), the Hong Kong Society of Rheumatology has developed consensus recommendations on the management of RA, which aim at providing guidance to local physicians on appropriate, literature-based management of this condition, specifically on the indications and monitoring of the biologic disease-modifying anti-rheumatic drugs (DMARDs). The recommendations were developed using the European League Against Rheumatism (EULAR) recommendations for the management of early arthritis as a guide, along with local expert opinion. As significant joint damage occurs early in the course of RA, initiating therapy early is key to minimizing further damage and disability. Patients with serious disease or poor prognosis should receive early, aggressive therapy. Because of its good efficacy and safety profile, methotrexate is considered the standard first-line DMARD for most treatment-naïve RA patients. Patients with a suboptimal response to methotrexate monotherapy should receive step-up (combination) therapy with either the synthetic or biologic DMARDs. In recent years, combinations of methotrexate with tocilizumab, abatacept, or rituximab have emerged as effective therapies in patients who are unresponsive to traditional DMARDs or the anti-tumor necrosis factor (TNF)-α agents. As biologic agents can increase the risk of infections such as tuberculosis and reactivation of viral hepatitis, screening for the presence of latent tuberculosis and chronic viral hepatitis carrier state is recommended before initiating therapy.
Literature
1.
Gabriel SE, Michaud K (2009) Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther 11:229PubMedCrossRef
2.
Lau E, Symmons D, Bankhead C et al (1993) Low prevalence of rheumatoid arthritis in the urbanized Chinese of Hong Kong. J Rheumatol 20:1133–1137PubMed
3.
Xiang YJ, Dai SM (2009) Prevalence of rheumatic diseases and disability in China. Rheumatol Int 29:481–490PubMedCrossRef
4.
Choy EH, Panayi GS (2001) Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med 344:907–916PubMedCrossRef
5.
Olech E, Freeston JE, Conaghan PG et al (2008) Using extremity magnetic resonance imaging to assess and monitor early rheumatoid arthritis: the optimal joint combination to be scanned in clinical practice. J Rheumatol 35:580–583PubMed
6.
Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324PubMedCrossRef
7.
Aletaha D, Neogi T, Silman AJ et al (2010) 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Ann Rheum Dis 69:1580–1588PubMedCrossRef
8.
Mok CC, for the working group on the use of TNF inhibitors for the treatment of rheumatic diseases in Hong Kong (2005) Consensus statements on the indications and monitoring of anti-tumor necrosis factor (TNF) therapy for rheumatic diseases in Hong Kong. Hong Kong Bull Rheum Dis 5:19–25
9.
Combe B, Landewe R, Lukas C et al (2007) EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 66:34–45PubMedCrossRef
10.
Lard LR, Visser H, Speyer I et al (2001) Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med 111:446–451PubMedCrossRef
11.
12.
Breedveld FC, Weisman MH, Kavanaugh AF et al (2006) The PREMIER Study. A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate therapy. Arthritis Rheum 54:26–37PubMedCrossRef
13.
St Clair EW, van der Heijde DM, Smolen JS et al (2004) Combination of infliximab and methotrexate therapy for early rheumatoid arthritis: a randomized, controlled trial. Arthritis Rheum 50:3432–3443PubMedCrossRef
14.
Grigor C, Capell H, Stirling A et al (2004) Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet 364:263–269PubMedCrossRef
15.
Nishimura K, Sugiyama D, Kogata Y et al (2007) Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med 146:797–808PubMed
16.
Wakefield RJ, Gibbon WW, Conaghan PG et al (2000) The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 43:2762–2770PubMedCrossRef
17.
Poleksic L, Zdravkovic D, Jablanovic D, Watt I, Bacic G (1993) Magnetic resonance imaging of bone destruction in rheumatoid arthritis: comparison with radiography. Skeletal Radiol 22:577–580PubMedCrossRef
18.
Fransen J, van Riel PL (2009) The disease activity score and the EULAR response criteria. Rheum Dis Clin North Am 35:745–757PubMedCrossRef
19.
20.
Saag KG, Cerhan JR, Kolluri S, Ohashi K, Hunninghake GW, Schwartz DA (1997) Cigarette smoking and rheumatoid arthritis severity. Ann Rheum Dis 56:463–469PubMedCrossRef
21.
Masdottir B, Jónsson T, Manfredsdottir V, Víkingsson A, Brekkan A, Valdimarsson H (2000) Smoking, rheumatoid factor isotypes and severity of rheumatoid arthritis. Rheumatology (Oxford) 39:1202–1205CrossRef
22.
Forslind K, Ahlmén M, Eberhardt K, Hafström I, BARFOT Study Group (2004) Prediction of radiological outcome in early rheumatoid arthritis in clinical practice: role of antibodies to citrullinated peptides (anti-CCP). Ann Rheum Dis 63:1090–1095PubMedCrossRef
23.
Möttönen T, Paimela L, Leirisalo-Repo M, Kautiainen H, Ilonen J, Hannonen P (1998) Only high disease activity and positive rheumatoid factor indicate poor prognosis in patients with early rheumatoid arthritis treated with “sawtooth” strategy. Ann Rheum Dis 57:533–539PubMedCrossRef
24.
Richi P, Balsa A, Muñoz-Fernández S et al (2002) Factors related to radiological damage in 61 Spaniards with early rheumatoid arthritis. Ann Rheum Dis 61:270–272PubMedCrossRef
25.
Young A, Koduri G (2007) Extra-articular manifestations and complications of rheumatoid arthritis. Best Pract Res Clin Rheumatol 21:907–927PubMedCrossRef
26.
Saag KG, Teng GG, Patkar NM et al (2008) American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum 59:762–784PubMedCrossRef
27.
Lillegraven S, Kvien TK (2007) Measuring disability and quality of life in established rheumatoid arthritis. Best Pract Res Clin Rheumatol 21:827–840PubMedCrossRef
28.
van der Heijde D, Klareskog L, Boers M et al (2005) Comparison of different definitions to classify remission and sustained remission: 1 year TEMPO results. Ann Rheum Dis 64:1582–1587PubMedCrossRef
29.
Weinblatt ME, Coblyn JS, Fox DA et al (1985) Efficacy of low-dose methotrexate in rheumatoid arthritis. N Engl J Med 312:818–822PubMedCrossRef
30.
Weinblatt ME, Kaplan H, Germain BF et al (1994) Methotrexate in rheumatoid arthritis. A five-year prospective multicenter study. Arthritis Rheum 37:1492–1498PubMedCrossRef
31.
Pincus T, Yazici Y, Sokka T, Aletaha D, Smolen JS (2003) Methotrexate as the “anchor drug” for the treatment of early rheumatoid arthritis. Clin Exp Rheumatol 21:S179–S185PubMed
32.
Mikuls TR, O’Dell JR (2000) The changing face of rheumatoid arthritis therapy: results of serial surveys. Arthritis Rheum 43:464–465PubMedCrossRef
33.
Felson DT, Anderson JJ, Meenan RF (1990) The comparative efficacy and toxicity of second-line drugs in rheumatoid arthritis: results of two metaanalyses. Arthritis Rheum 33:1449–1461PubMedCrossRef
34.
Boers M, Verhoeven AC, Markusse HM et al (1997) Randomized comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet 350:309–318PubMedCrossRef
35.
Landewe RB, Boers M, Verhoeven AC et al (2002) COBRA combination therapy in patients with early rheumatoid arthritis: long-term structural benefits of a brief intervention. Arthritis Rheum 46:347–356PubMedCrossRef
36.
Klareskog L, van der Heijde D, de Jager JP et al (2004) Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet 363:675–681PubMedCrossRef
37.
Finckh A, Bansback N, Marra CA et al (2009) Treatment of very early rheumatoid arthritis with symptomatic therapy, disease-modifying antirheumatic drugs, or biologic agents: a cost-effectiveness analysis. Ann Intern Med 151:668–669
38.
Kremer JM, Genovese MC, Cannon GW et al (2002) Concomitant leflunomide therapy in patients with active rheumatoid arthritis despite stable doses of methotrexate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 137:726–733PubMed
39.
40.
Möttönen T, Hannonen P, Leirisalo-Repo M et al (1999) Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomised trial. The Lancet 353:1568–1573CrossRef
41.
Weinblatt ME, Kremer JM, Bankhurst AD et al (1999) A trial of etanercept, a recombinant tumor necrosis factor receptor:Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. N Engl J Med 340:253–259PubMedCrossRef
42.
Keystone EC, Kavanaugh AF, Sharp JT et al (2004) Radiographic, clinical, and functional outcomes of treatment with adalimumab (a human anti-tumor necrosis factor monoclonal antibody) in patients with active rheumatoid arthritis receiving concomitant methotrexate therapy: a randomized, placebo-controlled, 52-week trial. Arthritis Rheum 50:1400–1411PubMedCrossRef
43.
Maini RN, Breedveld FC, Kalden JR et al (2004) Sustained improvement over 2 years in physical function, structural damage, and signs and symptoms among patients with rheumatoid arthritis treated with infliximab and methotrexate. Arthritis Rheum 50:1051–1065PubMedCrossRef
44.
Emery P, Keystone E, Tony HP et al (2008) IL-6 receptor inhibition with tocilizumab improves treatment outcomes in patients with rheumatoid arthritis refractory to anti-tumour necrosis factor biologics: results from a 24-week multicentre randomised placebo-controlled trial. Ann Rheum Dis 67:1516–1523PubMedCrossRef
45.
Maini RN, Taylor PC, Szechinski J et al (2006) Double-blind randomized controlled clinical trial of the interleukin-6 receptor antagonist, tocilizumab, in European patients with rheumatoid arthritis who had an incomplete response to methotrexate. Arthritis Rheum 54:2817–2829PubMedCrossRef
46.
Smolen JS, Beaulieu A, Rubbert-Roth A et al (2008) Effect of interleukin-6 receptor inhibition with tocilizumab in patients with rheumatoid arthritis (OPTION study): a double-blind, placebo-controlled, randomised trial. Lancet 371:987–997PubMedCrossRef
47.
Jones G, Sebba A, Gu J et al (2010) Comparison of tocilizumab monotherapy versus methotrexate monotherapy in patients with moderate to severe rheumatoid arthritis: the AMBITION study. Ann Rheum Dis 69:88–96PubMedCrossRef
48.
Kremer J, Fleischmann R, Halland A, et al. (2008) Tocilizumab inhibits structural joint damage in rheumatoid arthritis patients with an inadequate response to methotrexate: the LITHE study [abstract]. Ann Rheum Dis;58:abstr L14.
49.
Kremer JM, Genant HK, Moreland LW et al (2006) Effects of abatacept in patients with methotrexate-resistant active rheumatoid arthritis: a randomized trial. Ann Intern Med 144:865–876PubMed
50.
Kremer JM, Genant HK, Moreland LW et al (2008) Results of a two-year followup study of patients with rheumatoid arthritis who received a combination of abatacept and methotrexate. Arthritis Rheum 58:953–963PubMedCrossRef
51.
Cohen SB, Emery P, Greenwald MW et al (2006) Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary efficacy and safety at 24 weeks. Arthritis Rheum 54:2793–2806PubMedCrossRef
52.
Genovese MC, Becker JC, Schiff M et al (2005) Abatacept for rheumatoid arthritis refractory to tumor necrosis factor alpha inhibition. N Engl J Med 353:1114–1123PubMedCrossRef
53.
Isaacs JD, Olech E, Tak PP et al (2009) Autoantibody-positive rheumatoid arthritis (RA) patients (pts) have enhanced clinical response to rituximab (RTX) when compared with seronegative patients. Ann Rheum Dis 68(Suppl 3):442
54.
Keane J (2005) TNF-blocking agents and tuberculosis: new drugs illuminate an old topic. Rheumatology 44:714–720PubMedCrossRef
55.
American Thoracic Society, Centers for Disease Control and Prevention (2000) This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med 161:S221–S247
56.
Calabrese LH, Zein NN, Vassilopoulos D (2006) Hepatitis B virus (HBV) reactivation with immunosuppressive therapy in rheumatic diseases: assessment and preventive strategies. Ann Rheum Dis 65:983–989PubMedCrossRef
57.
Nathan DM, Angus PW, Gibson PR (2006) Hepatitis B and C virus infections and anti-tumor necrosis factor-α therapy: Guidelines for clinical approach. J Gastroenterol Hepatol 21:1366–1371PubMedCrossRef
58.
Matsue K, Kimura SI, Takanashi Y, et al. (2010) Reactivation of hepatitis B virus after rituximab-containing treatment in patients with CD20-positive B-cell lymphoma. Cancer. [Epub ahead of print]
59.
Ji D, Cao J, Hong X, et al. (2010) Low incidence of hepatitis B virus reactivation during chemotherapy among diffuse large B-cell lymphoma patients who are HBsAg-negative/HBcAb-positive: a multicenter retrospective study. Eur J Haematol. [Epub ahead of print]
60.
Stone JH, Holbrook JT, Marriott MA et al (2006) Solid malignancies among patients in the Wegener's Granulomatosis Etanercept Trial. Arthritis Rheum 54:1608–1618PubMedCrossRef
61.
Askling J, Fored CM, Brandt L et al (2005) Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists. Ann Rheum Dis 64:1421–1426PubMedCrossRef
62.
Geborek P, Bladström A, Turesson C et al (2005) Tumour necrosis factor blockers do not increase overall tumour risk in patients with rheumatoid arthritis, but may be associated with an increased risk of lymphomas. Ann Rheum Dis 64:699–703PubMedCrossRef
63.
Mann DL, McMurray JJ, Packer M et al (2004) Targeted anticytokine therapy in patients with chronic heart failure: results of the Randomized Etanercept Worldwide Evaluation (RENEWAL). Circulation 109:1594–1602PubMedCrossRef
64.
Chung ES, Packer M, Lo KH, Fasanmade AA (2003) Anti-TNF Therapy Against Congestive Heart Failure Investigators. Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial. Circulation 107:3133–3140PubMedCrossRef
65.
Ramos-Casals M, Roberto-Perez-Alvarez, Diaz-Lagares C, Cuadrado MJ, Khamashta MA, BIOGEAS Study Group (2010) Autoimmune diseases induced by biologic agents: a double-edged sword? Autoimmun Rev 9:188–193PubMedCrossRef
66.
Galloway JB, Hyrich KL, Mercer LK, et al. (2010) Anti-TNF therapy is associated with an increased risk of serious infections in patients with rheumatoid arthritis especially in the first 6 months of treatment: updated results from the British Society for Rheumatology Biologics Register with special emphasis on risks in the elderly. Rheumatology (Oxford). [Epub ahead of print]
67.
Listing J, Strangfeld A, Kary S et al (2005) Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis Rheum 52:3403–3412PubMedCrossRef
68.
Curtis JR, Patkar N, Xie A et al (2007) Risk of serious bacterial infections among rheumatoid arthritis patients exposed to tumor necrosis factor antagonists. Arthritis Rheum 56:1125–1133PubMedCrossRef
69.
Koike R, Harigai M, Atsumi T et al (2009) Japan College of Rheumatology 2009 guidelines for the use of tocilizumab, a humanized anti-interleukin-6 receptor monoclonal antibody, in rheumatoid arthritis. Mod Rheumatol 19:351–357PubMedCrossRef
70.
Schimmel EK, Yazici Y (2009) Increased lipid levels but unchanged atherogenic index in rheumatoid arthritis patients treated with biologic disease modifying antirheumatic drugs: published experience. Clin Exp Rheumatol 27:446–451PubMed
71.
Han C, Robinson DW, Hackett MV et al (2006) Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. J Rheumatol 33:2167–2172PubMed
72.
Turesson C, Jarenros A, Jacobsson L (2004) Increased incidence of cardiovascular disease in patients with rheumatoid arthritis: results from a community based study. Ann Rheum Dis 63:952–955PubMedCrossRef
73.
Solomon DH, Karlson EW, RImm EB et al (2003) Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation 107:1303–1307PubMedCrossRef
74.
Wolfe F, Freundlich B, Straus WL (2003) Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis. J Rheumatol 30:36–40PubMed
75.
Peters MJ, Symmons DP, McCarey D et al (2010) EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 69:325–331PubMedCrossRef
76.
Deane K (2006) Increased prevalence translates into increased fractures—Osteoporosis in RA: a common comorbidity. J Musculoskel Med 23:838–844
Metadata
Title
Management of rheumatoid arthritis: consensus recommendations from the Hong Kong Society of Rheumatology
Authors
Chi Chiu Mok
Lai Shan Tam
Tak Hin Chan
Gavin K. W. Lee
Edmund K. M. Li
Hong Kong Society of Rheumatology
Publication date
01-03-2011
Publisher
Springer-Verlag
Published in
Clinical Rheumatology / Issue 3/2011
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-010-1596-y

Other articles of this Issue 3/2011

Clinical Rheumatology 3/2011 Go to the issue

Brief Report

Erdheim–Chester disease

Case Based Review

A case of antisynthetase syndrome in a rheumatoid arthritis patient with anti-PL-12 antibody following treatment with etanercept

Erratum

Erratum to: Enthesitis in seronegative spondyloarthropathies with special attention to the knee joint by MRI: a step forward toward understanding disease pathogenesis

Original Article

Prevalence of paraneoplastic rheumatic syndromes and their antibody profile among patients with solid tumours

Brief Report

Musculoskeletal examination—an ignored aspect. Why are we still failing the patients?

Original Article

The presence of anti-citrullinated protein antibodies (ACPA) does not affect the clinical response to adalimumab in a group of RA patients with the tumor necrosis factor (TNF) α-308 G/G promoter polymorphism
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits