2024 update of the recommendations of the French Society of Rheumatology for the diagnosis and management of patients with rheumatoid arthritis - 24/11/24

Doi : 10.1016/j.jbspin.2024.105790

Bruno Fautrel ^a,^b,^c,^d,^⁎ , Joanna Kedra ^a,^b,^c,^d, Claire Rempenault ^e,^f, Pierre-Antoine Juge ^g,^h,ⁱ, Juliette Drouet ^c, Jérôme Avouac ^j,^e,^k, Athan Baillet ^l, Olivier Brocq ^m, Guillermo Carvajal Alegria ^n,^o,^p, Arnaud Constantin ^q,^r,^s, Emmanuelle Dernis ^t, Cécile Gaujoux-Viala ^u,^v, Vincent Goëb ^w, Jacques-Eric Gottenberg ^x, Benoit Le Goff ^y, Hubert Marotte ^z,^aa, Christophe Richez ^ab,^ac, Jean-Hugues Salmon ^ad, Alain Saraux ^ae,^af, Eric Senbel ^ag, Raphaèle Seror ^ah,^ai, Anne Tournadre ^aj, Olivier Vittecoq ^ak, Pascale Escaffre ^al, Danielle Vacher ^am, Philippe Dieudé ^g,^an, Claire Daien ^h,^i,^ao
^a Sorbonne université, Paris, France
^b Service de rhumatologie, groupe hospitalier Pitié-Salpêtrière, Assistance publique–Hôpitaux de Paris, 75013 Paris, France
^c Inserm UMRS 1136, PEPITES Team, 75013 Paris, France
^d CRI-IMIDIATE Clinical Research Network, 75013 Paris, France
^e Université Paris-Cité, Paris, France
^f Service de rhumatologie, groupe hospitalier Bichat – Claude-Bernard, Assistance publique–Hôpitaux de Paris, 75018 Paris, France
^g Inserm UMRS 1152, équipe 2, 75018 Paris, France
^h Université de Montpellier, Montpellier, France
ⁱ Service de rhumatologie, CHU de Montpellier, CHU Lapeyronie, Montpellier, France
^j Department of Rheumatology, Hôpital Cochin, AP–HP, Paris, France
^k Inserm U1016, UMR 8104, Paris, France
^l TIMC, UMR 5525, university Grenoble-Alpes, Grenoble, France
^m Rheumatology, Princess-Grace Hospital, boulevard Pasteur, 98000 Monaco, Monaco
ⁿ Service de rhumatologie, hôpital Trousseau, CHRU de Tours, 37044 Tours cedex, France
^o UFR Medicine, University of Tours, Tours, France
^p UPR 4301 CNRS Centre de Biophysique Moléculaire, Nanomedicaments et Nanosondes Department, Tours, France
^q Service de rhumatologie, hôpital Pierre-Paul-Riquet, CHU de Purpan, Toulouse, France
^r Université de Toulouse III – Paul-Sabatier, Toulouse, France
^s INFINITY, Inserm UMR 1291, CHU de Purpan, Toulouse, France
^t University of Caen, CHU, Department of Rheumatology, Caen, France
^u Inserm, IDESP, University of Montpellier, Montpellier, France
^v Rheumatology Department, CHU of Nîmes, Nîmes, France
^w Rheumatology, Autonomy Unit, UPJV, CHU of Amiens-Picardie, 80000 Amiens, France
^x Rheumatology Department, CHU of Strasbourg, 68000 Strasbourg, France
^y Rheumatology Department, CHU of Nantes, 44000 Nantes, France
^z Rheumatology Department, Université Jean-Monnet Saint-Étienne, Saint-Étienne, France
^aa Inserm, SAINBIOSE U1059, Mines Saint-Étienne, CHU of Saint-Etienne, 42023 Saint-Étienne, France
^ab Service de rhumatologue, centre national de référence des maladies auto-immunes systémiques rares RESO, Bordeaux, France
^ac UMR/CNRS 5164, ImmunoConcEpT, CNRS, hôpital Pellegrin, université de Bordeaux, CHU de Bordeaux, Bordeaux, France
^ad Rheumatology Department, CHU of Reims, 51000 Reims, France
^ae Université de Bretagne-Occidentale, université de Brest, Brest, France
^af Inserm (U1227), LabEx IGO, Department of Rheumatology, CHU of Brest, 29200 Brest, France
^ag Conseil National Professionnel de Rhumatologie, France
^ah Department of Rheumatology, Hôpital Bicêtre, AP–HP, Paris, France
^ai Inserm-UMR 1184, centre national de référence des maladies auto-immunes systémiques rares, université Paris-Saclay, Le Kremlin-Bicêtre, France
^aj UNH INRAe UCA, Rheumatology Department, CHU of Clermont-Ferrand, Clermont-Ferrand, France
^ak Rheumatology Department, CHU of Rouen, Rouen, France
^al AFPric, 75011 Paris, France
^am ANDAR, 75014 Paris, France
^an Service de rhumatologie, groupe hospitalier Bichat, université de Paris, Assistance publique–Hôpitaux de Paris, 75018 Paris, France
^ao Inserm U1046, CNRS UMR 9214, University of Montpellier, Physiology and Experimental Medicine of the Heart and Muscles (PhyMedExp), Montpellier, France

^⁎Corresponding author. Service de rhumatologie, groupe hospitalier Pitié-Salpêtrière, Assistance publique–Hôpitaux de Paris, 75013 Paris, France.Service de rhumatologie, groupe hospitalier Pitié-Salpêtrière, Assistance publique–Hôpitaux de ParisParis75013France

Graphical abstract

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Highlights

•	The topics addressed in this update are: (1) diagnosis and therapeutic management of RA, (2) management of people at risk of RA, (3) management of RA-related interstitial lung disease (RA-ILD).
•	The general principles emphasize the importance of a shared decision between the rheumatologist and patient and the need for comprehensive management, both drug and non-drug, for people with RA or at risk of RA development.
•	In terms of diagnosis, the recommendations stress the importance of clinical arthritis and in its absence, the risk factors for progression to RA.
•	The recommendations incorporate recent data on the cardiovascular and neoplastic risk profile of Janus kinase inhibitors.
•	The recommendations highlight the need for high-resolution CT scan in the presence of pulmonary symptoms. RA-ILD management requires collaboration between rheumatologists and pulmonologists, and is based on controlling disease activity.

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Abstract

The French Society of Rheumatology recommendations for managing rheumatoid arthritis (RA) has been updated by a working group of 21 rheumatology experts, 4 young rheumatologists and 2 patient association representatives on the basis of the 2023 version of the European Alliance of Associations for Rheumatology (EULAR) recommendations and systematic literature reviews. Two additional topics were addressed: people at risk of RA development and RA-related interstitial lung disease (RA-ILD). Four general principles and 19 recommendations were issued. The general principles emphasize the importance of a shared decision between the rheumatologist and patient and the need for comprehensive management, both drug and non-drug, for people with RA or at risk of RA development. In terms of diagnosis, the recommendations stress the importance of clinical arthritis and in its absence, the risk factors for progression to RA. In terms of treatment, the recommendations incorporate recent data on the cardiovascular and neoplastic risk profile of Janus kinase inhibitors. With regard to RA-ILD, the recommendations highlight the importance of clinical screening and the need for high-resolution CT scan in the presence of pulmonary symptoms. RA-ILD management requires collaboration between rheumatologists and pulmonologists. The treatment strategy is based on controlling disease activity with methotrexate or targeted therapies (mainly abatacept or rituximab). The prescription for anti-fibrotic treatment should be discussed with a pulmonologist with expertise in RA-ILD.

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Keywords : Rheumatoid arthritis, People at risk of rheumatoid arthritis, Interstitial lung disease, Therapeutics, Targeted therapies, Biologics, DMARD, JAK inhibitors, Management, Recommendations for clinical practice