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2016 update of the EULAR recommendations for the management of early arthritis
  1. Bernard Combe1,
  2. Robert Landewe2,
  3. Claire I Daien1,
  4. Charlotte Hua1,
  5. Daniel Aletaha3,
  6. Jose María Álvaro-Gracia4,
  7. Margôt Bakkers5,
  8. Nina Brodin6,7,
  9. Gerd R Burmester8,
  10. Catalin Codreanu9,
  11. Richard Conway10,
  12. Maxime Dougados11,
  13. Paul Emery12,
  14. Gianfranco Ferraccioli13,
  15. Joao Fonseca14,15,
  16. Karim Raza16,17,
  17. Lucía Silva-Fernández18,
  18. Josef S Smolen3,
  19. Diana Skingle5,
  20. Zoltan Szekanecz19,
  21. Tore K Kvien20,
  22. Annette van der Helm-van Mil21,22,
  23. Ronald van Vollenhoven23
  1. 1Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France
  2. 2Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, Amsterdam and Zuyderland Medical Centre, Heerlen, The Netherlands
  3. 3Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
  4. 4Biological Therapies Unit, Servicio de Reumatología. Hospital Universitario de la Princesa, IIS-IP, Madrid, Spain
  5. 5EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
  6. 6Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
  7. 7Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden
  8. 8Department of Rheumatology and Clinical Immunology, Charité—University Medicine Berlin, Berlin, Germany
  9. 9Department of Rheumatology, Center for Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
  10. 10Department of Rheumatology, Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin Academic Medical Centre, Dublin, Ireland
  11. 11Medicine Faculty, APHP, Rheumatology B Department, Paris Descartes University, Cochin Hospital, Paris, France
  12. 12Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
  13. 13Fondazione Policlinico Gemelli Academic Hospital, Catholic University School of Medicine, Rome, Italy
  14. 14Rheumatology Department, Hospital de Santa Maria, Lisbon Academic Medical Centre, Lisbon
  15. 15Instituto de Medicina Molecular, Faculdade de Medicina Universidade de Lisboa, Portugal
  16. 16Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
  17. 17Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  18. 18Rheumatology Department, Complexo Hospitalario Universitario de Ferrol, A Coruña, Spain
  19. 19Faculty of Medicine, Department of Rheumatology, University of Debrecen, Debrecen, Hungary
  20. 20Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  21. 21Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  22. 22Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
  23. 23Department of Clinical Immunology & Rheumatology, Academic Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Professor Bernard Combe, Rheumatology Department, Lapeyronie Hospital, Montpellier University, Montpellier cedex 5 34295, France; b-combe{at}


Objectives Since the 2007 recommendations for the management of early arthritis have been presented, considerable research has been published in the field of early arthritis, mandating an update of the 2007 European League Against Rheumatism (EULAR) recommendations for management of early arthritis.

Methods In accordance with the 2014 EULAR Standardised Operating Procedures, the expert committee pursued an approach that was based on evidence in the literature and on expert opinion. The committee involved 20 rheumatologists, 2 patients and 1 healthcare professional representing 12 European countries. The group defined the focus of the expert committee and target population, formulated a definition of ‘management’ and selected the research questions. A systematic literature research (SLR) was performed by two fellows with the help of a skilled librarian. A set of draft recommendations was proposed on the basis of the research questions and the results of the SLR. For each recommendation, the categories of evidence were identified, the strength of recommendations was derived and the level of agreement was determined through a voting process.

Results The updated recommendations comprise 3 overarching principles and 12 recommendations for managing early arthritis. The selected statements involve the recognition of arthritis, referral, diagnosis, prognostication, treatment (information, education, pharmacological and non-pharmacological interventions), monitoring and strategy. Eighteen items were identified as relevant for future research.

Conclusions These recommendations provide rheumatologists, general practitioners, healthcare professionals, patients and other stakeholders with an updated EULAR consensus on the entire management of early arthritis.

  • Early Rheumatoid Arthritis
  • Rheumatoid Arthritis
  • Treatment
  • DMARDs (synthetic)
  • Patient perspective

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  • Handling editor Hans WJ Bijlsma

  • BC and RL are joint first authors.

  • Contributors BC and RL wrote the first draft. CID and CH performed the systematic literature review. All authors have participated in the generation of the recommendations, have revised critically the manuscript and approved the final version.

  • Funding This initiative was supported by an unrestricted grant from the European League Against Rheumatism.

  • Competing interests All the participants in this initiative have disclosed conflict of interest. The individual declaration of conflict of interest is available on demand at the European League Against Rheumatism secretariat and is summarised below: BC has received honoraria from BMS, Janssen, Eli Lilly, Merck, Novartis, Pfizer, Roche-Chugai, Sanofi and UCB, and research grants from Pfizer, Roche-Chugai and UCB. RL has received honoraria and/or research grants from AbbVie, Ablynx, Amgen, AstraZeneca, Bristol-Myers Squibb, Celgene, Janssen, Galapagos, GlaxoSmithKline (GSK), Novartis, Novo-Nordisk, Merck, Pfizer, Roche, Schering-Plough, TiGenix, UCB. RL is director of Rheumatology Consultancy BV. CID has received honoraria from BMS, Merck, Pfizer, Roche-Chugai and UCB. DA has received honoraria from AbbVie, BMS, Centocor, Janssen, Eli Lilly, Medac, Merck, Pfizer, Roche and UCB. JMA-G has received honoraria from AbbVie, BMS, MSD, Novartis, Pfizer, Roche, Sanofi and UCB, and research grants from MSD, Pfizer, Roche and UCB. GRB has received honoraria from AbbVie, BMS, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Roche-Chugai and UCB, and research grants from Pfizer, Roche-Chugai and UCB. CC has received speaker and consulting fees from AbbVie, Amgen, Angellini, AstraZeneca, Bristol-Myers Squibb, Egis, MSD, Pfizer, Richter, Roche, Sanofi, Servier, Teva, UCB, Zentiva. RC has received honoraria from AbbVie, Roche, Pfizer and Amgen. MD has received honorarium fees for participating at advisory boards or symposia organised by Pfizer, AbbVie, UCB, Roche, Eli Lilly, Novartis, Sanofi, Merck, BMS. His department has received research grants from Pfizer, AbbVie, UCB, Roche, Eli Lilly, Novartis, Sanofi, Merck, BMS. PE has provided expert advice for AbbVie, AstraZeneca, BMS, Eli Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, Samsung, UCB. GF has received honoraria from AbbVie, Pfizer, MSD, Roche, Janssen, Eli Lilly, UCB and research grants from Roche, MSD. JF has received unrestricted research grants or acted as a speaker for AbbVie, Amgen, BMS, Biogen, Celltrion, Celgene, Hospira, Janssen, MSD, Novartis, Novo-Nordisk, Pfizer, Roche, UCB. KR has received honoraria from AbbVie, Pfizer, Roche and Janssen and research grants from AbbVie. JSS has received grants for his institution from AbbVie, Janssen, Eli Lilly, MSD, Pfizer, Roche and has provided expert advice to and/or had speaking engagements for AbbVie, Amgen, AstraZeneca, Astro, Celgene, Celltrion, GSK, ILTOO, Janssen, Eli Lilly, Medimmune, MSD, Novartis-Sandoz, Pfizer, Roche, Samsung, Sanofi, UCB. ZS has received consultant and speakers fees from AbbVie, MSD, Bristol-Myers Squibb, Roche, Pfizer. TKK has received fees for speaking and/or consulting from Biogen, BMS, Boehringer Ingelheim, Celltrion, Eli Lilly, Epirus, Hospira, Merck-Serono, Novartis, Orion Pharma, Pfizer, Sandoz and UCB. RvV has received research support and grants from AbbVie, Amgen, BMS, GSK, Pfizer, Roche, UCB, and honoraria for consultancy from AbbVie, Biotest, BMS, Celgene, Crescendo, GSK, Janssen, Eli Lilly, Merck, Novartis, Pfizer, Roche, UCB, Vertex.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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