Navigating ACR’s RA Treatment Guidelines, with Bryant England, MD, PhD

In an interview with HCPLive, Bryant England, MD, PhD, associate professor in the Division of Rheumatology at the University of Nebraska Medical Center, discusses his 2024 Congress of Clinical Rheumatology (CCR) East presentation that focuses on the American College of Rheumatology (ACR)'s clinical practice guidelines—with an emphasis on the pharmacologic and integrative treatment guidelines—to help clinicians incorporate the latest recommendations into their clinical practice.

As a part of the core team for the pharmacologic guideline and the co-principal investigator for the integrative guideline, England emphasizes that they integrate the best available evidence, clinical experiences, and patient values and preferences. This evidence-based approach is particularly vital in chronic diseases like rheumatoid arthritis (RA), where treatment decisions require continuous assessment and adaptation based on evolving evidence and patient circumstances.

These guidelines touch on a variety of recommendations relevant to RA and are available through multiple channels, including guideline summaries on the ACR website, presentations at annual meetings, and publication in reputable journals, with final versions available to ACR members.

If incorporating the entirety of guideline recommendations with limited clinic time sounds daunting, England has some advice:

“One of the things to know is that you don't have to cover everything at every visit,” he said. “You can prioritize. If someone comes in with a new diagnosis of rheumatoid arthritis, obviously, the importance of that visit is going to be about making the diagnosis, educating the patient about the diagnosis, getting them started on disease modifying therapies, and giving them a lay of the land of the other things out there to help with RA management. At a follow up visit, after they've gotten comfortable with that medicine and you're assessing the response, you may have more time at that visit to then go into some of these other things. You don’t have to do it all at once.”

Regarding his personal strategies for using these recommendations for guiding his own practice, he believes clinical trial evidence provides a strong foundation, but clinicians must consider real-world patient characteristics, comorbidities, and social determinants of health to tailor treatments effectively. Engaging patients in treatment discussions by presenting options and discussing their preferences fosters a collaborative approach to care.

Disclosures: England receives research support to his institution from Boehringer Ingelheim.