In this issue of the Annals of Rheumatic Diseases, the EULAR task force, working together with the subgroups who conducted detailed reviews of available data on five specific topics on rheumatoid arthritis (RA) also published in this issue, present their recommendations for the management of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs). 1,–,6 This follows the similar effort by the American College of Rheumatology (ACR) in 20087 and is a welcome addition to the current thinking and discussion about the management of RA. Taken together, these recommendations are both comprehensive and evidence-based and provide a framework for standardising care of patients with RA.

The task force, with the help of the subgroups, has put together 3 overarching principles and 15 recommendations. The overarching principles state correctly that RA needs to be treated by a rheumatologist, who can likely better manage disease activity and treatment guided by a target score, as very well demonstrated in studies such as TICORA, BeSt and FinRACo, to name a few.8,–,10 Although only one of these studies included a treatment arm with a biological agent,9 intervention in early disease was generally superior to that in trials of patients with established disease who received biological agents.

Unfortunately, the use of objective treatment targets as the rationale for defining therapy is not yet as widespread as it could be—especially in the USA where these measurement tools have yet to be routinely incorporated into care of the patient with RA. The treatment of patients with RA is better now than in past decades, an improvement often attributed to the development of biological therapies. Although biological agents are an important advance for a significant number of patients with RA, three other major developments also seem to …