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. BakerKamil 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

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)1108-1123
Number of pages16
JournalArthritis and Rheumatology
Issue number7
StatePublished - Jul 2021

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology


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