Management of rheumatoid arthritis (RA) is complex. The ever-expanding availability of new drugs requires that rheumatologists and patients constantly consider treatment strategies and targets aimed at both disease control and symptom relief while remaining cognizant of the increasing high cost of emerging medications. Given such complexity, guidelines to inform rheumatologists about the most recent developments on managing RA have been appearing every three years or so.
In 2015, the ACR published an updated guideline; previous versions were published in 2012 and 2008.1-3 Most recently, the European League Against Rheumatism (EULAR) released its RA guidelines updated in 2016; previous ones were published in 2013 and 2010.4-6 The frequency of these updated guidelines suggests the importance for rheumatologists to keep up with the fast pace of the evidence to ensure the many and new treatment options available are tailored to individual patients and offered to all patients. This is particularly important given the high cost of many of the agents, such as biologics, that limit their widespread use.
This is aptly stated in the 2016 EULAR guidelines: “Management recommendations on the approach to treating patients with RA have become increasingly useful in providing physicians, patients, payers, regulators and other healthcare suppliers with evidence-based guidance supported by the views of experts involved in many of these novel developments.”4