Clinical recommendations

This chapter will review the most important recommendations that are relevant for evidence-based clinical practice. The main focus will be on recommendations that are specific to rheumatoid arthritis (RA) but some recommendation on special topics (e.g. biosimilars) will also be addressed. The literature to support evidence-based medicine is enormous, but the scientific quality may differ across studies. Recommendations based on systematic literature research may support evidence-based practice. Both the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) have published several important evidence-based recommendations. Further, task forces independent of these organizations have also presented important recommendations to support best practice. New treatment strategies have also improved RA care to an extent where remission has become an achievable goal for the majority of patients with RA. Important principles in the new treatment strategies are ‘window of opportunity’ which imply early initiation of disease-modifying antirheumatic drugs (DMARDs) before the onset of damage, and further ‘treat-to-target’ which is a strategy for follow-up with focus on reaching a predefined target, and where DMARD treatment is adjusted if the target is not achieved. Patients with early disease are monitored with ‘tight controls’, and with use of composite disease activity measures that includes joint counts.