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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe European League Against Rheumatism Standing Committee on International Clinical Studies, including Therapeutic Trials regularly establishes and publishes evidence-based recommendations for the management of rheumatic disorders, as well as recommendation for conducting\/reporting clinical trials. Each of these recommendations is developed by a combined approach involving both review of available research evidence and expert consensus; incorporation of a third type of evidence \u2013 patient opinion \u2013 is now undertaken for management recommendations. This article discusses several new and revised recommendations.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Erheumatological autoimmune disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Earthritis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Evasculitis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eguidelines\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EThe EULAR Standing Committee on International Clinical Studies, including Therapeutic Trials (ESCISIT) regularly establishes and publishes evidence-based recommendations for the management of rheumatic disorders, as well as recommendation for conducting\/reporting clinical trials. Each of these recommendations is developed by a combined approach involving both review of available research evidence and expert consensus; incorporation of a third type of evidence \u2013 patient opinion \u2013 is now undertaken for management recommendations. The recommendations are reviewed and updated as required to remain current with changes in technology and research advances. At this year\u0027s EULAR congress in Barcelona, several new and revised recommendations were announced.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EEULAR Recommendations for Vasculitis\u003C\/h2\u003E\n         \u003Cdiv id=\u0022sec-3\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003ESystemic Vasculitis\u003C\/h3\u003E\n            \u003Cp id=\u0022p-3\u0022\u003EPatients with primary systemic vasculitis should be treated in collaboration with expert centers. Patients with antibody associated systemic vasculitis (AAV) should be categorized according to European Vasculitis Study Group recommendations. A combination of cyclophosphamide (IV or oral) and glucocorticoids should be used to induce remission of generalized or severe AAV; methotrexate and glucocorticoids may be used for remission induction of localized or early systemic AAV. In severe disease, plasma exchange will improve renal survival. Azathioprine or methotrexate is appropriate for maintenance of remission.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-4\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EPrimary Small Vessel Vasculitis\u003C\/h3\u003E\n            \u003Cp id=\u0022p-4\u0022\u003ELong term regular follow-up is recommended for patients with prior exposure to cyclophosphamide, and with persistent unexplained hematuria.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-5\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003ELarge\/Giant Vessel Arteritis\u003C\/h3\u003E\n            \u003Cp id=\u0022p-5\u0022\u003EHigh dose glucocorticoids should be used to induce remission. Visual symptoms of giant cell arteritis should be treated with a short course of high dose IV glucocorticoids. Patients with giant cell arteritis, with previous cardiac, visual or ischemic symptoms should be treated with low-dose aspirin.\u003C\/p\u003E\n         \u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-6\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EEULAR Recommendations for the Management of Beh\u00e7et\u0027s Disease\u003C\/h2\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ERecommendations on vascular disease, neurological and gastrointestinal involvement are based mainly on expert opinion due to a lack of controlled evidence.\u003C\/p\u003E\n         \u003Cdiv id=\u0022sec-7\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EEye Disease\u003C\/h3\u003E\n            \u003Cp id=\u0022p-7\u0022\u003EAzathioprine and systemic corticosteroids should be included in the treatment regimen for patients with inflammatory eye disease affecting the posterior segment. Severe eye disease is most appropriately treated with either cyclosporine A or infliximab combined with azathioprine and corticosteroids.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-8\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EVascular Disease\u003C\/h3\u003E\n            \u003Cp id=\u0022p-8\u0022\u003EImmunosuppressive agents (eg, corticosteroids, azathioprine, cyclophosphamide, cyclosporine) are recommended for the management of acute deep vein thrombosis. For the management of both pulmonary and peripheral arterial aneurysms, cyclophosphamide and corticosteroids are recommended. There are no controlled data on, or evidence of benefit from uncontrolled experience with, anticoagulants, anti-platelet or anti-fibrinolytic agents in the management of deep vein thrombosis or for the use of anticoagulation for the arterial lesions of Beh\u00e7et\u0027s disease (BD).\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-9\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EGastrointestinal Involvement\u003C\/h3\u003E\n            \u003Cp id=\u0022p-9\u0022\u003EThere is no evidence-based treatment that can be recommended for the management of gastrointestinal involvement of BD. Agents such as sulfasalazine, corticosteroids, azathioprine, TNF antagonists, or thalidomide should be tried first, before proceeding with surgery, except in emergencies.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-10\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003ECentral Nervous System (CNS) Involvement\u003C\/h3\u003E\n            \u003Cp id=\u0022p-10\u0022\u003ECorticosteroids, interferon-alpha, azathioprine, cyclophosphamide, methotrexate, and TNF antagonists may be appropriate for parenchymal involvement. For dural sinus thrombosis corticosteroids are recommended. Cyclosporine should only be used in patients with CNS involvement if necessary for treatment of intraocular inflammation.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-11\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003ESkin and Mucosa\u003C\/h3\u003E\n            \u003Cp id=\u0022p-11\u0022\u003EMucocutaneous involvement should be treated according to the dominant or co-dominant lesions present. Topical measures (ie, local steroids) should be the first-line of treatment for isolated oral and genital ulcers. Acne-like lesions are usually of cosmetic concern only. Thus, topical measures as used in acne vulgaris are sufficient. Colchicine should be used when the dominant lesion is genital ulcer or erythema nodosum. Leg ulcers might have different causes. For these ulcers, azathioprine, interferon-alpha and TNF antagonists may be considered in resistant cases.\u003C\/p\u003E\n         \u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-12\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EEULAR Recommendations on the Management of Systemic Glucocorticoid Therapy in Rheumatic Diseases\u003C\/h2\u003E\n         \u003Cdiv id=\u0022sec-13\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EPatient Education\u003C\/h3\u003E\n            \u003Cp id=\u0022p-12\u0022\u003EThe adverse effects of glucocorticoid therapy should be considered and discussed with the patient before therapy is started.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-14\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EDosing\u003C\/h3\u003E\n            \u003Cp id=\u0022p-13\u0022\u003EThe glucocorticoid dose depends on the underlying rheumatic disease, disease activity, risk factors and individual patient response. Comorbidities and risk factors for adverse effects should be evaluated and treated when therapy is first initiated. For prolonged treatment, the glucocorticoid dosage should be kept to a minimum and a glucocorticoid taper should be attempted in the case of remission or low disease activity.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-15\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EMonitoring\u003C\/h3\u003E\n            \u003Cp id=\u0022p-14\u0022\u003EPatients should be monitored for body weight, blood pressure, peripheral edema, cardiac insufficiency, serum lipids, blood and\/or urine glucose, and ocular pressure depending on the individual patient\u0027s risk, glucocorticoid dose, and duration.\u003C\/p\u003E\n            \u003Cp id=\u0022p-15\u0022\u003EPatients receiving prednisone \u22657.5 mg daily for \u0026gt;3 months should receive supplemental calcium and vitamin D. Antiresorptive therapy with bisphosphonates to reduce the risk of glucocorticoid-induced osteoporosis should be based on risk factors, including bone mineral density.\u003C\/p\u003E\n            \u003Cp id=\u0022p-16\u0022\u003EPatients treated with glucocorticoids and concomitant NSAIDs should be given appropriate gastro-protective medication (eg, proton pump inhibitors, misoprostol).\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-16\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003ESpecial Conditions\u003C\/h3\u003E\n            \u003Cp id=\u0022p-17\u0022\u003EPatients on glucocorticoid therapy for \u0026gt;1 month, who will undergo surgery, must receive perioperative management with adequate glucocorticoid replacement to overcome potential adrenal insufficiency. Glucocorticoids during pregnancy have no additional risk for mother and child. Children receiving glucocorticoids should be checked regularly for linear growth and considered for growth hormone replacement in the case of growth impairment.\u003C\/p\u003E\n         \u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-17\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EEULAR Recommendations for the Diagnosis of Osteoarthritis of the Hand\u003C\/h2\u003E\n         \u003Cdiv id=\u0022sec-18\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003ERisk Factors\u003C\/h3\u003E\n            \u003Cp id=\u0022p-18\u0022\u003ERisk factors for hand osteoarthritis (OA) include: female gender, increasing age (\u0026gt;40 years), menopausal status, family history, obesity, higher bone density, greater forearm muscle strength, joint laxity, prior hand injury, and occupation or recreation-related usage.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-19\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003ESymptoms\u003C\/h3\u003E\n            \u003Cp id=\u0022p-19\u0022\u003ETypical symptoms are pain on usage and only mild morning or inactivity stiffness affecting just one or a few joints at any one time; symptoms are often intermittent and target characteristic sites (DIPJs, PIPJs, thumb-base, index and middle MCPJs).\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-20\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EClinical Presentation\u003C\/h3\u003E\n            \u003Cp id=\u0022p-20\u0022\u003EClinical hallmarks include Heberden\u0027s and Bouchard\u0027s nodes, and\/or bony enlargement with or without deformity affecting characteristic target joints (DIPJs, PIPJs, thumb-base, and index and middle MCPJs).\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-21\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EAssociated Risks\/Subsets\u003C\/h3\u003E\n            \u003Cp id=\u0022p-21\u0022\u003EPatients with polyarticular OA of the hand are at increased risk of OA of the knee, hip, and other common target sites and should be assessed and examined accordingly. Recognised subsets with different risk factors, associations and outcomes (requiring different assessment and management) include IPJ (with or without nodes), thumb-base, and erosive OA.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-22\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EDiagnosis\u003C\/h3\u003E\n            \u003Cp id=\u0022p-22\u0022\u003EThe differential diagnosis for OA of the hand is wide. The most common conditions to consider are psoriatic arthritis; rheumatoid arthritis, gout, and hemochromatosis. Radiographs provide the gold standard for morphological assessment of OA of the hand. Blood tests are not required for diagnosis but may be required to exclude co-existent disease.\u003C\/p\u003E\n         \u003C\/div\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/4\/20.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm9je\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}