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 Josef S Smolen A1 Robert Landewé A1 Johannes Bijlsma A1 Gerd Burmester A1 Katerina Chatzidionysiou A1 Maxime Dougados A1 Jackie Nam A1 Sofia Ramiro A1 Marieke Voshaar A1 Ronald van Vollenhoven A1 Daniel Aletaha A1 Martin Aringer A1 Maarten Boers A1 Chris D Buckley A1 Frank Buttgereit A1 Vivian Bykerk A1 Mario Cardiel A1 Bernard Combe A1 Maurizio Cutolo A1 Yvonne van Eijk-Hustings A1 Paul Emery A1 Axel Finckh A1 Cem Gabay A1 Juan Gomez-Reino A1 Laure Gossec A1 Jacques-Eric Gottenberg A1 Johanna M W Hazes A1 Tom Huizinga A1 Meghna Jani A1 Dmitry Karateev A1 Marios Kouloumas A1 Tore Kvien A1 Zhanguo Li A1 Xavier Mariette A1 Iain McInnes A1 Eduardo Mysler A1 Peter Nash A1 Karel Pavelka A1 Gyula Poór A1 Christophe Richez A1 Piet van Riel A1 Andrea Rubbert-Roth A1 Kenneth Saag A1 Jose da Silva A1 Tanja Stamm A1 Tsutomu Takeuchi A1 René Westhovens A1 Maarten de Wit A1 Désirée van der Heijde 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.