RT Journal Article SR Electronic T1 EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update JF Annals of the Rheumatic Diseases JO Ann Rheum Dis FD BMJ Publishing Group Ltd and European League Against Rheumatism SP 960 OP 977 DO 10.1136/annrheumdis-2016-210715 VO 76 IS 6 A1 Smolen, Josef S A1 Landewé, Robert A1 Bijlsma, Johannes A1 Burmester, Gerd A1 Chatzidionysiou, Katerina A1 Dougados, Maxime A1 Nam, Jackie A1 Ramiro, Sofia A1 Voshaar, Marieke A1 van Vollenhoven, Ronald A1 Aletaha, Daniel A1 Aringer, Martin A1 Boers, Maarten A1 Buckley, Chris D A1 Buttgereit, Frank A1 Bykerk, Vivian A1 Cardiel, Mario A1 Combe, Bernard A1 Cutolo, Maurizio A1 van Eijk-Hustings, Yvonne A1 Emery, Paul A1 Finckh, Axel A1 Gabay, Cem A1 Gomez-Reino, Juan A1 Gossec, Laure A1 Gottenberg, Jacques-Eric A1 Hazes, Johanna M W A1 Huizinga, Tom A1 Jani, Meghna A1 Karateev, Dmitry A1 Kouloumas, Marios A1 Kvien, Tore A1 Li, Zhanguo A1 Mariette, Xavier A1 McInnes, Iain A1 Mysler, Eduardo A1 Nash, Peter A1 Pavelka, Karel A1 Poór, Gyula A1 Richez, Christophe A1 van Riel, Piet A1 Rubbert-Roth, Andrea A1 Saag, Kenneth A1 da Silva, Jose A1 Stamm, Tanja A1 Takeuchi, Tsutomu A1 Westhovens, René A1 de Wit, Maarten A1 van der Heijde, Désirée YR 2017 UL http://ard.bmj.com/content/76/6/960.abstract AB Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recommendations address conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GC); biological (b) DMARDs (tumour necrosis factor (TNF)-inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, clazakizumab, sarilumab and sirukumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (Janus kinase (Jak) inhibitors tofacitinib, baricitinib). Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. Cost aspects were taken into consideration. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at >50% improvement within 3 and target attainment within 6 months. If this fails stratification is recommended. Without unfavourable prognostic markers, switching to—or adding—another csDMARDs (plus short-term GC) is suggested. In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered. For each recommendation, levels of evidence and Task Force agreement are provided, both mostly very high. These recommendations intend informing rheumatologists, patients, national rheumatology societies, hospital officials, social security agencies and regulators about EULAR's most recent consensus on the management of RA, aimed at attaining best outcomes with current therapies.