2024 Update of the Asia-Pacific League of Associations for Rheumatology (APLAR) Recommendations for Rheumatoid Arthritis Management.

AIM: To update the Asia-Pacific League of Associations for Rheumatology (APLAR) treatment recommendations for rheumatoid arthritis (RA) by incorporating new evidence and reassessing the validity of previous guidance:

METHODS

A literature search for relevant publications from January 2018 to August 2023 was conducted, supplemented by earlier studies where relevant. Recommendations were formulated based on this evidence and refined through a modified-Delphi process during a series of online meetings. The quality of evidence and strength of recommendations were assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

RESULTS

This update comprises 14 statements that achieved consensus during the meetings. Topics covered include measurement of disease activity and treatment response, the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), the use of targeted therapies, vaccination and screening for infections and the use of DMARDs during pregnancy. The recommendations address the selection of disease activity scores, initiation and intensification of therapy using csDMARDs and targeted therapies, and management of RA in patients at risk of reactivation of infectious diseases. These recommendations are discussed in the context of the clinical landscape encountered in the Asia-Pacific region.

CONCLUSION

These updated recommendations complement previous APLAR guidelines and aim to support best practice management of RA across the Asia-Pacific region. They provide a practical framework for national rheumatology associations to develop local guidelines adapted to their specific needs and clinical practice.