Rheumatology International

, Volume 39, Issue 9, pp 1483–1497 | Cite as

Kuwait association of rheumatology 2018 treatment recommendations for patients with rheumatoid arthritis

  • Hebah AlhajeriEmail author
  • Fatemah Abutiban
  • Wasl Al-Adsani
  • Adel Al-Awadhi
  • Ali Aldei
  • Ahmad AlEnizi
  • Naser Alhadhood
  • Adeeba Al-Herz
  • Waleed Alkandari
  • Ahmad Dehrab
  • Aqeel A. Muhanna Ghanem
  • Eman Hasan
  • Sawsan Hayat
  • Khulood Saleh
  • Hoda Tarakmeh
  • Yaser Ali


The Kuwait Association of Rheumatology (KAR) aimed to develop a set of recommendations for the treatment of patients with rheumatoid arthritis (RA), tailored to the unique patient population and healthcare system of Kuwait. Each recommendation was developed based on expert opinion and evaluation of clinical practice guidelines from other international and national rheumatology societies. Online surveys were conducted to collate feedback on each KAR member’s level of agreement (LoA) with definitions of disease-/treatment-related terms used and the draft recommendations. Definitions/recommendations achieving a pre-defined cut-off value of ≥ 70% agreement were accepted for inclusion. Remaining statements were discussed and revised at a face-to-face meeting, with further modifications until consensus was reached. A final online survey was used to collect feedback on each KAR member’s LoA with the final set of recommendation statements on a scale of 0 (complete disagreement) to 10 (complete agreement). Group consensus was achieved on 66 recommendation statements, including 3 overarching principles addressing the pharmacological treatment and management of RA. Recommendations focused on treatment of early RA, established RA, patients with high-risk comorbidities, women during pregnancy and breastfeeding, and screening and treatment of opportunistic infections. The KAR 2018 Treatment Recommendations for RA reported here are based on a synthesis of other national/international guidelines, supporting literature, and expert consensus considering the Kuwaiti healthcare system and RA patient population. These recommendations aim to inform the clinical decisions of rheumatologists treating patients in Kuwait, and to promote best practices, enhance alignment and improve the treatment experience for patients.


DMARDs (biologic) DMARDs (synthetic) Tumor necrosis factor-alpha Anti-TNF Early rheumatoid arthritis Rheumatoid arthritis Pregnancy Infections Treatment 



The authors thank Peter C. Taylor, MA, PhD, FRCP, FRCPE, for his independent review of the KAR 2018 Recommendations for RA. The authors also acknowledge Hinal Tanna, PhD, and Debbie Nixon, DPhil from Costello Medical, Cambridge, UK, for facilitating the recommendations meeting and surveys, and for medical writing and editorial assistance in preparing this manuscript for publication, based on the authors’ input and direction.

Author contributions

HA, FA, WAA, AAA, AA, AAE, NA, AAH, WA, AD, AAMG, EH, SH, KS, HT, and YA contributed to the conception, design, acquisition or analysis, and interpretation of the data. All authors approved the final version to be published after critically revising the manuscript for important intellectual content.


The KAR received unrestricted funds for the development of the KAR 2018 treatment recommendations for patients with RA from Eli Lilly, NewBridge Pharmaceuticals, Roche, and Pfizer.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Supplementary material

296_2019_4372_MOESM1_ESM.pdf (301 kb)
Supplementary material 1 (PDF 300 kb)
296_2019_4372_MOESM2_ESM.docx (28 kb)
Supplementary material 2 (DOCX 28 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hebah Alhajeri
    • 1
    Email author
  • Fatemah Abutiban
    • 2
  • Wasl Al-Adsani
    • 1
  • Adel Al-Awadhi
    • 3
  • Ali Aldei
    • 4
  • Ahmad AlEnizi
    • 2
  • Naser Alhadhood
    • 5
  • Adeeba Al-Herz
    • 4
  • Waleed Alkandari
    • 5
  • Ahmad Dehrab
    • 6
  • Aqeel A. Muhanna Ghanem
    • 1
  • Eman Hasan
    • 4
  • Sawsan Hayat
    • 1
  • Khulood Saleh
    • 5
  • Hoda Tarakmeh
    • 1
  • Yaser Ali
    • 1
  1. 1.Mubarak Al-Kabeer HospitalJabriyaKuwait
  2. 2.Al Jahra HospitalAl JahraKuwait
  3. 3.Department of MedicineKuwait UniversityKuwait CityKuwait
  4. 4.Al Amiri HospitalKuwait CityKuwait
  5. 5.Farwaniya HospitalAl FarwaniyaKuwait
  6. 6.Adan HospitalHadiyaKuwait

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