2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis

Liana Fraenkel, Joan M Bathon, Bryant R England, E William St Clair, Thurayya Arayssi, Kristine Carandang, Kevin D Deane, Mark Genovese, Kent Kwas Huston, Gail Kerr, Joel Kremer, Mary C Nakamura, Linda A Russell, Jasvinder A Singh, Benjamin J Smith, Jeffrey A Sparks, Shilpa Venkatachalam, Michael E Weinblatt, Mounir Al-Gibbawi, Joshua F Baker, Kamil E Barbour, Jennifer L Barton, Laura Cappelli, Fatimah Chamseddine, Michael George, Sindhu R Johnson, Lara Kahale, Basil S Karam, Assem M Khamis, Iris Navarro-Millán, Reza Mirza, Pascale Schwab, Namrata Singh, Marat Turgunbaev, Amy S Turner, Sally Yaacoub, Elie A Akl
Arthritis & Rheumatology 2021 June 8

OBJECTIVE: To develop updated guidelines for the pharmacologic management of rheumatoid arthritis.

METHODS: We developed clinically relevant population, intervention, comparator, and outcomes (PICO) questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A voting panel comprising clinicians and patients achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.

RESULTS: The guideline addresses treatment with disease-modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs, use of glucocorticoids, and use of DMARDs in certain high-risk populations (i.e., those with liver disease, heart failure, lymphoproliferative disorders, previous serious infections, and nontuberculous mycobacterial lung disease). The guideline includes 44 recommendations (7 strong and 37 conditional).

CONCLUSION: This clinical practice guideline is intended to serve as a tool to support clinician and patient decision-making. Recommendations are not prescriptive, and individual treatment decisions should be made through a shared decision-making process based on patients' values, goals, preferences, and comorbidities.

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