Guideline Video

Guideline Resources

  • Management of Rheumatoid Arthritis with Synthetic and Biologic Disease-Modifying Antirheumatic Drugs
  • European League Against Rheumatism (EULAR)
  • March 13, 2026
  • Summary
  • Full-text

Video Transcription

Just published March 13th, 2026, the European League Against Rheumatism’s newest guideline on Management of Rheumatoid Arthritis with Synthetic and Biologic Disease-Modifying Antirheumatic Drugs.

The objective of this guideline is to provide an update of the European Alliance of Associations for Rheumatology rheumatoid arthritis management recommendations addressing the most recent insights.

In today’s rapid update, we’ll just be going over a key summary of the recommendations. For the full guideline, make sure to check it out on guidelinecentral.com

Let’s get started. 

  • Therapy with disease-modifying antirheumatic drugs, or DMARDs should be started as soon as the diagnosis of rheumatoid arthritis is made.
  • Treatment should be aimed at reaching a target of sustained remission or low disease activity in every patient. 
  • Disease activity monitoring should be frequent in active disease; if there is no improvement by at most 3 mo after the start of treatment or the target has not been reached by 6 mo, therapy should be adjusted; when the target is sustained, monitoring can be less frequent. 
  • Methotrexate or MTX should be part of the first treatment strategy; in patients with a contraindication to MTX, leflunomide or sulfasalazine should be considered. 
  • Short-term glucocorticoids should be considered when initiating or changing csDMARDs, in different dose regimens and routes of administration, but should be tapered and discontinued as rapidly as clinically feasible. 
  • If the treatment target is not achieved with the csDMARD strategy, a bDMARD should be added; Janus kinase, or JAK inhibitors may be considered, but pertinent risk factors must be taken into account. 
  • bDMARDs/tsDMARDs should be combined with a csDMARD; in patients who cannot use csDMARDs as comedication, IL-6 pathway inhibitors and JAK inhibitors may have some advantages compared with other bDMARDs. 
  • If a bDMARD or tsDMARD has failed, treatment with another bDMARD or a tsDMARD+ should be considered; if 1 TNF or IL-6 receptor inhibitor therapy has failed, patients may receive an agent with another mode of action or a second TNF-/IL-6R-inhibitor.
  • After glucocorticoids have been discontinued and a patient is in sustained remission, continuation of DMARDs is recommended, but dose reduction may be considered. 

And there you have it. Make sure to check out the full guideline from the European League Against Rheumatism and other related clinical decision support tools at guidelinecentral.com.

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