One of the guidelines that we are focusing is called BC Guideline: British Columbia Guideline. This guide is narrowing down to instant management as soon as the signs and symptoms of Rheumatoid Arthritis are clear. This action will lead to the intervention thus resulting in positive results. The amalgamation of the traditional means and emerging biological therapies are changing the steps of Rheumatoid Arthritis leading to Disease Modifying Anti-Rheumatic drugs (DMARDs), which when used at an early stage leads to the drastic altering of the disease thus the low probability of RA effects (Simon et al., 2002). This medical paradigm is not only inclined to the control of symptoms at early stages but also dismantlement of the disease actions which leads to the prevention of adverse effects like permanent disability of joints.
The other guideline is called the American College of Rheumatology (ACR) Guideline for the treatment of Rheumatoid Arthritis. This method is eyeing the level and quality of evidence available using the Grading of Recommendations Assessment Development and Evaluation (GRADE), which qualifies the recommendation as either active or conditional. ACR uses DMARDs, biological agents, tofacitinib, and glucocorticoids for a period of fewer than six months and established at a time of more or equals to six months (Kwoh et al., 2002). This method has room for those patients suffering from other methods like hepatitis, congestive heart failure and that is a biological agent.
The Developer and Date of Development
The British Columbia (BC) Guideline, founded by the committee of Medical Services Commission called the Guidelines and Protocol Advisory Committee (GPAC). September 30, 2012, is the effective date of the BC, Rheumatoid Arthritis- Diagnosis, Management and Monitoring guideline. GPAC journey dates back in 1993 working agreement. The prime role is to ensure the effectiveness and provision of high-quality medical services to patients. In the development of this guide, a criterion that is as follows. Identification of the area where there is high risk is the first step, which is RA (Klareskog at al., 2004). Obtaining the evidence of effective treatment and the chance of reducing mortality and morbidity is the second step. Choosing of the cost-effective methods and prioritizing for specific results follows. Finally, the physicians and stakeholders chip in, in the analysis of the evidence.
The Core Leadership Team is the origin of the American College of Rheumatology (ACR) Guideline for the treatment of Rheumatoid Arthritis. The last publishing of ACR is in the year 2012, updating the 2008 RA guideline. The critical roles of Core Leadership Team are defining the project scope, drafting the clinical questions as per the instruction and drafting the manuscript. The chair of the team is JAS who posses all-rounded regarding expertise. EAA is also part of the group which advice on the processes and the GRADE findings. As a principle, the team focuses on the prominent cases, the cost of the procedure analysis, measurement of disease activity, assessment of the functional state, the decision of switching of the therapy, and finally, gives the favorable recommendation at this point.
The primary objective of BC guideline is to provide a platform for early identification of RA hence administering medication to patients in the first phases thus the disease curbing. Apart from that, the guideline aids the physician to undermine the disease activities with a mission of preventing severe damages of the joints of the patients, which may cause permanent impairment. The ACR aims to give suggestions in a certain way and pattern of medication to patients who are suffering from RA with a target of treating and preventing the disease. The two guidelines have the same objective of wanting to give recommendations on the prevention of the Rheumatic Arthritis. However, the British Columbia guideline is inclining to the prevention of the disease at the early phase while the American College of Rheumatology is determined to give suggestions of RA treatment and prevention throughout the lifetime of the patients ( Ding et al., 2010).
The British Columbia guide targets at medical fraternity which are the physicians, nurse practitioners, medical students, health educators, health authorities, allied health organizations, pharmacists, and nurses. On the other side, the American College of Rheumatology aims at both the clinicians and patients. The two guidelines target the clinicians, but the ACR differs with BC in that it focuses the patients with the RA. This difference exists mainly because of the discrepancy on the approach of the guideline in that, the BC concentrates on the early times of the disease, and thus the patients are excluded while the ACR looks at the entire period of the illness hence patients included.
Major Outcomes Considered
The BC guideline considers the patients to be of two categories; the early RA is representing patients with signs of less than three-month period and patients with established disease and effects like inflammation and joint damage. This grouping leads to different treatment approach. One of the primary considerations to make is not to rely on the outcomes of the lab since no tests can give a valid diagnosis. Apart from that, early RA is to undergo checkups monthly to monitor the treatment and any side effects that may be occurring. The long-term DMARD therapy is having a follow-up of between three to six months and specialist investigation from month six to the twelfth after inflammation. According to ACR, the balance of relative of advantages and disadvantages of the treatment should be in consideration. This consideration gives the quality of facts about the patients' figures and their likes and dislikes as per grade.
As per the BC, recommending the early RA to have patients guide is essential.They are to start NSAIDs to assist in pain management. Hydroxychloroquine of dose (5-7) is vital until RA is confirmed. To a person having established RA, drug therapy is the best, which includes dosage and monitoring of the side effects. We recommend the examination of the joints for any inflammation. If there is an indication of active inflammation, then medication regimen adherence is the suggestion. Otherwise, the recommendation of pain relieving modalities and surgical opinion is the way to go. Using the ACR guideline, early RA is encouraged to adopt the treat-to-target strategy approach, its level of evidence is low (17) ( Simon et al., 2002). If the disease activity is small, we recommend the usage of DMARD. If the event remains moderate or high, then DMARDs and TNF is the option. On tackling the established RA, at medium (44-46) level, we recommend the adoption of treat-to-target strategy. For the patients with the previously treated lymph proliferative disorder, the recommendation of rituximab over TNF with very low (105,107) is the best.
Rationale for guideline use
I would choose to adopt the American College of Rheumatology. This guideline gives and perfect remedy procedures various issues like if the patient has an existing disease like Hepatitis, then he or she should follow particular steps which British Columbia does not give.
American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. (2002). Guidelines for the management of rheumatoid arthritis, 2002 update. Arthritis Rheum., 46, 328-346.
Ding, T., Ledingham, J., Luqmani, R., Westlake, S., Hyrich, K., Lunt, M., ... & Ostor, A. (2010). BSR and BHPR rheumatoid arthritis guidelines on safety of anti-TNF therapies. Rheumatology, 49(11), 2217-2219.
Kwoh, C. K., Anderson, L. G., Greene, J. M., Johnson, D. A., O'Dell, J. R., Robbins, M. L., ... & Yood, R. A. (2002). Guidelines for the management of rheumatoid arthritis: 2002 update-American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Arthritis and Rheumatism, 46(2), 328-346.
Klareskog, L., van der Heijde, D., de Jager, J. P., Gough, A., Kalden, J., Malaise, M., ... & Wajdula, J. (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. The Lancet, 363(9410), 675-681.
Simon, L., Smolen, J., Strand, V., Sharp, J., Boers, M., Breedveld, F., ... & Lipsky, P. (2002). How to report radiographic data in randomised clinical trials in rheumatoid arthritis: guidelines from a roundtable discussion. Arthritis Care & Research, 47(2), 215-218
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