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TREATMENT OF RA | 925 INTRODUCTION To support high-quality clinical care, the American College of Rheumatology (ACR) regularly updates clinical practice guidelines for the management of rheumatoid arthritis (RA), with the most recent update reported in 2015 (1). The current recommendations address treatment with the following: 1) conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biologic DMARDs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs); 2) glucocorticoids; and 3) use of these medications in certain high-risk populations. The use of vaccines and nonpharmacologic treatment approaches (although initially part of this project) will be covered in future ACR treatment guideline publications. For recommendations regarding pretreatment screening and routine laboratory monitoring, we refer readers to the 2008, 2012, and 2015 guidelines (1–3), with newly approved therapies following the screening process recommended for other medications in the same class. Recommendations for the perioperative management of patients undergoing elective orthopedic surgery are addressed in the 2017 guideline for perioperative management (4). For recommendations regarding reproductive health, we refer readers to the 2020 ACR Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases (5). In keeping with the Grading of Recommendations Assessment, Development and Evaluation [GRADE] methodology), the ACR panel developed recommendations for commonly encountered clinical scenarios (6–8). Both strong and conditional recommendations required achieving a 70% level of agreement by the voting panel. Each recommendation is qualified as being strong or conditional. In this context, strong recommendations are those for which the panel is highly confident that the recommended option favorably balances the expected benefits and risks for the majority of patients in clinical practice. In contrast, conditional recommendations are those for which the panel is less confident that the potential benefits outweigh the risks. A recommendation can be conditional either because of low or very low certainty in the evidence supporting one option over another, or because of an expectation of substantial variations in patient preferences for the options under consideration. METHODS This guideline follows the ACR guideline development process and ACR policy guiding the management of conflicts of interest and disclosures (https://www.rheumatology.org/Practice-Quality/ Clinical-Support/Clinical-Practice-Guidelines) (6,8), which includes GRADE methodology (6,8), and abides by the AGREE Reporting Checklist to ensure the completeness and transparency of reporting in practice guidelines (9). Supplementary Appendix 1, available on the Arthritis Care & Research website at http://onlin University Medical Center, Durham, North Carolina; 5 Thurayya Arayssi, MD: Weill Cornell Medicine–Qatar, Doha, Qatar; 6 Kristine Carandang, PhD, OTR/L: University of California, San Diego; 7 Kevin D. Deane, MD, PhD: University of Colorado, Aurora; 8 Mark Genovese, MD: Stanford University Medical Center, Palo Alto, California; 9 Kent Kwas Huston, MD: The Center for Rheumatic Disease/Allergy and Immunology, Kansas City, Missouri; 10Gail Kerr, MD, FRCP (Edin): Veterans Affairs Medical Center, Georgetown and Howard University, Washington, DC; 11Joel Kremer, MD: Albany Medical College and The Center for Rheumatology, Albany, New York; 12Mary C. Nakamura, MD: University of California, San Francisco; 13Linda A. Russell, MD: Hospital for Special Surgery, New York, New York; 14Jasvinder A. Singh, MD, MPH: University of Alabama at Birmingham and Birmingham
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