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Non-pharmacological and pharmacological interventions in patients with early arthritis: a systematic literature review informing the 2016 update of EULAR recommendations for the management of early arthritis
  1. Claire Immediato DAIEN1,
  2. Charlotte HUA1,
  3. Bernard COMBE1 and
  4. Robert LANDEWE2
  1. 1Rheumatology department, Lapeyronie Hospital, Montpellier University, Montpellier, France
  2. 2Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, Amsterdam & Zuyderland Medical Centre, Heerlen, The Netherlands
  1. Correspondence to Dr Claire Immediato DAIEN; cidaien{at}


Objective To perform a systematic literature review (SLR) on pharmacological and non-pharmacological treatments, in order to inform the European League Against Rheumatism (EULAR) recommendations for the management of early arthritis (EA).

Methods The expert committee defined research questions concerning non-pharmacological interventions, patient information and education, non-steroidal anti-inflammatory drug, glucocorticoid (GC) and disease-modifying antirheumatic drugs (DMARDs) use, as well as on disease monitoring. The SLR included articles published after the last EULAR SLR until November 2015 found in the MEDLINE, EMBASE and Cochrane databases and abstracts from the 2014 and 2015 American College of Rheumatology and EULAR conferences.

Results Exercise programmes may improve pain and physical function in patients with EA. Patients with EA treated within the first 3 months of symptoms have better clinical and radiological outcomes than those treated beyond 3 months. The clinical and radiological efficacy of GCs is confirmed, with similar efficacy of oral and parenteral administrations. Long-term data raise concerns regarding cardiovascular safety when using GCs. Step-up DMARD therapy is as effective as intensive DMARD therapy ‘ab initio’ for the long-term outcome of EA. Short-term superiority of intensive therapy with bDMARDs is not maintained on withdrawal of bDMARD. Patients with early psoriatic arthritis have better skin and joint outcomes when tight control is used compared to standard care.

Conclusions The findings confirm the beneficial effect of exercise programmes and the importance of early drug therapy and tight control. They support the use of methotrexate and GCs as first-line drugs, although the long-term use of GCs raises safety concerns.

  • Early Rheumatoid Arthritis
  • Physcial therapy
  • DMARDs (biologic)
  • DMARDs (synthetic)
  • Corticosteroids

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  • Contributors CID and CH performed the systematic literature review and wrote the manuscript. BC and RL defined the research questions, supervised the work and revised the manuscript.

  • Funding EULAR.

  • Competing interests The individual declaration of conflicts of interest is available on demand at the EULAR secretariat and is summarised below: CID has received honoraria from BMS, MSD, Pfizer, Roche-Chugai and UCB, and research grants from MSD, Pfizer, Roche-Chugai and UCB. BC has received honoraria from BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai and UCB, and research grants from Pfizer, Roche-Chugai and UCB. RL has received honoraria and/or research grants from AbbVie, Ablynx, Amgen, Astra-Zeneca, Bristol Myers Squibb, Celgene, Janssen, Galapagos, Glaxo-Smith-Kline, Novartis, Novo-Nordisk, Merck, Pfizer, Roche, TiGenix and UCB. RL is director of Rheumatology Consultancy BV.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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