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EULAR recommendations for disease management: guidance not guidelines
  1. David S Pisetsky
  1. Department of Medicine, Duke University Medical Center, Durham VAMC, Durham, North Carolina 27705, USA
  1. Correspondence to Dr David S Pisetsky, Department of Medicine, Medical Research Service, 151G, Durham VAMC, Durham, NC 27705, USA; david.pisetsky{at}

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The past two decades have witnessed remarkable advances in the treatment of inflammatory arthritis that have made remission in previously untreatable conditions a realistic goal for many patients. These advances derive from new insights into disease mechanisms; the advent of the biologics and other new therapies; the development of robust measures of disease activity; coherent treatment strategies to guide therapy (ie, treat to target or T2T); and a sufficient supply of rheumatologists to implement the new approaches.1

The advances in rheumatology have been unprecedented and, arguably, the treatment of inflammatory arthritis has progressed faster and further than that of any other serious chronic disease in all of medicine. Indeed, a patient with rheumatoid arthritis (RA) today can lead an essentially normal life, whereas, a few decades ago, such a patient would have a restricted existence and be easily recognised by the appearance of grave illness, wasting and deformity.

Along with better outcomes have come challenges in the utilisation of the current armamentarium of disease modifying antirheumatic drugs or DMARDs (table 1). These challenges are, of course, welcome since they signify progress. In the face of literally hundreds to thousands of ways to treat arthritis and the continuing influx of novel agents, they also demand guidance for both providers and patients to establish a treatment plan, recognising potential risks, benefits and costs. The publication of three articles on European League Against Rheumatism (EULAR) recommendations for the treatment of early inflammatory arthritis, RA and axial spondyloarthritis (axSpA) is therefore an important event and provides a much needed perspective and framework for the delivery of best care.2–4

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Table 1

Disease-modifying antirheumatic drugs (DMARDs)

Each article represents a remarkable effort by panels of rheumatologists, health professionals and patient representatives to encompass an ever-expanding literature and provide overarching principles as well as specific recommendations. The work …

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