EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs

Josef S. Smolen*, Robert Landewe, Ferdinand C. Breedveld, Maxime Dougados, Paul Emery, Cecile Gaujoux-Viala, Simone Gorter, Rachel Knevel, Jackie Nam, Monika Schoels, Daniel Aletaha, Maya Buch, Laure Gossec, Tom W J Huizinga, Johannes W J Bijlsma, Gerd Burmester, Bernard Combe, Maurizio Cutolo, Cem Gabay, Juan Gomez-ReinoMarios Kouloumas, Tore K. Kvien, Emilio Martin-Mola, Iain B. McInnes, Karel Pavelka, Piet van Riel, Marieke Scholte-Voshaar, David L. Scott, Tuulikki Sokka, Guido Valesini, Ronald F. van Vollenhoven, Kevin L. Winthrop, John Q. Wong, Angela Zink, Desiree van der Heijde

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Treatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-a-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion.
Original languageEnglish
Pages (from-to)964-975
JournalAnnals of the Rheumatic Diseases
Issue number6
Publication statusPublished - Jun 2010

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