Table 1

The updated recommendations (2014), including a comparison with the 2010 version

Overarching principles*
20142010†
A.The treatment of rheumatoid arthritis must be based on a shared decision between patient and rheumatologistA.The treatment of rheumatoid arthritis must be based on a shared decision between patient and rheumatologist
B.The primary goal of treating patients with rheumatoid arthritis is to maximise long-term health-related quality of life through control of symptoms, prevention of structural damage, normalisation of function and participation in social and work-related activitiesB.The primary goal of treating the patient with rheumatoid arthritis is to maximise long-term health-related quality of life through control of symptoms, prevention of structural damage, normalisation of function and social participation
C.Abrogation of inflammation is the most important way to achieve these goalsC.Abrogation of inflammation is the most important way to achieve these goals
D.Treatment to target by measuring disease activity and adjusting therapy accordingly optimises outcomes in rheumatoid arthritisD.Treatment to target by measuring disease activity and adjusting therapy accordingly optimises outcomes in rheumatoid arthritis
Final set of 10 recommendations on treating rheumatoid arthritis to target based on both evidence and expert opinion*
20142010
1.The primary target for treatment of rheumatoid arthritis should be a state of clinical remission1.The primary target for treatment of rheumatoid arthritis should be a state of clinical remission
2.Clinical remission is defined as the absence of signs and symptoms of significant inflammatory disease activity2.Clinical remission is defined as the absence of signs and symptoms of significant inflammatory disease activity
3.While remission should be a clear target, low-disease activity may be an acceptable alternative therapeutic goal, particularly in long-standing disease3.While remission should be a clear target, based on available evidence low-disease activity may be an acceptable alternative therapeutic goal, particularly in established long-standing disease
4The use of validated composite measures of disease activity, which include joint assessments, is needed in routine clinical practice to guide treatment decisions6.The use of validated composite measures of disease activity, which include joint assessments, is needed in routine clinical practice to guide treatment decisions
5The choice of the (composite) measure of disease activity and the target value should be influenced by comorbidities, patient factors and drug-related risks9.The choice of the (composite) measure of disease activity and the level of the target value may be influenced by consideration of comorbidities, patient factors and drug-related risks
6.Measures of disease activity must be obtained and documented regularly, as frequently as monthly for patients with high/moderate disease activity or less frequently (such as every six months) for patients in sustained low-disease activity or remission5.Measures of disease activity must be obtained and documented regularly, as frequently as monthly for patients with high/moderate disease activity or less frequently (such as every 3–6 months) for patients in sustained low-disease activity or remission
7.Structural changes, functional impairment and comorbidity should be considered when making clinical decisions, in addition to assessing composite measures of disease activity7.Structural changes and functional impairment should be considered when making clinical decisions, in addition to assessing composite measures of disease activity
8.Until the desired treatment target is reached, drug therapy should be adjusted at least every three months*4.Until the desired treatment target is reached, drug therapy should be adjusted at least every three months
9.The desired treatment target should be maintained throughout the remaining course of the disease8.The desired treatment target should be maintained throughout the remaining course of the disease
10.The rheumatologist should involve the patient in setting the treatment target and the strategy to reach this target10.The patient has to be appropriately informed about the treatment target and the strategy planned to reach this target under the supervision of the rheumatologist

  • The actual changes are highlighted in the online supplementary table.

  • *As worded, these recommendations constitute solely a brief summary of the discussions on individual aspects of the Task Force's activity. The Task Force specifies that these recommendations must not be interpreted without taking the respective text accompanying each item into account.

  • †The numbers at the left of the 2010 recommendations refer to the original numbering at that time.