With better strategies and optimal use of traditional and biologic DMARDs, RA disease control and the achievement of long-standing remission, even with drug de-escalation, have become achievable goals in the vast majority of patients. Therefore, our efforts are naturally shifting towards the screening, treatment and control of the many comorbidities seen in patients with RA.
Towards this end, the EULAR has come up with "points of discussion." What the heck is that? I just learned something new! GUIDELINES are somewhat legally binding, RECOMMENDATIONS are statements based on evidence, and Points of Discussion are recognised as important issues to address but lack, so far, strong evidence to be made into recommendations.
The areas covered by the EULAR points of discussion are the obvious ones: osteoporosis, cardiovascular disease, infections, cancer, and depression. It is highly advised that we recognise, screen and act upon these common comorbidities.
There were separate CV Recommendations, which also included AS and PsA. But they are a big step backwards compared to the previous 2009 recommendations. They are all over the place without any logical flow, mixing imaging biomarkers, the use of statins, encouraging physical activity, and no mention of other more specific lifestyle changes such as smoking cessation, or disease activity control.
Hopefully, once in a manuscript (within the next few months) the EULAR's points of discussion will be more clearly spelled out. I strongly suggest reading and adopting the Canadian Recommendations, accepted for publication in J Rheumatology, and soon to be released.