EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update

Ann Rheum Dis. 2013 doi: 10.1136/annrheumdis-2013-204573

The 2010 EULAR recommendations represented a significant step forward in the management of rheumatoid arthritis, and they have been widely adopted across the world. However, in the rapidly evolving world of rheumatology, it was recognised that a substantial amount of new evidence has accumulated, both on agents approved at that time as well as data on new compounds that have become available over the last 3–4 years. This motivated EULAR to form an international task force to update their recommendations for the management of RA. The overarching principles of the recommendations were shifted to bring the patient into even greater focus by enhancing the importance of shared decision-making. The benefit of adding low dose glucocorticoids to DMARDs has been further confirmed since 2010 and recommendations have been updated to strengthen the wording accordingly. For existing bDMARDs such as tocilizumab and rituximab, recommendations were adjusted and optimised on the basis of new evidence, and the overall number was reduced to 14 (from 15 in 2010). In addition, there are two major new inclusions: biosimilars and, significantly for cytokine signalling, tofacitinib, the first tsDMARD to be mentioned in the EULAR recommendations for RA.