title: Recommendations of the French Society for Rheumatology for managing rheumatoid arthritis.
abstract: BACKGROUND
  This article reports the latest recommendations of the French Society for Rheumatology (SFR) regarding the management of rheumatoid arthritis (RA).
  
  
  METHODS
  New recommendations were developed by hospital- and community-based rheumatologists having extensive experience with RA and a patient self-help organization representative. They rest on the recently issued EULAR recommendations and a literature review.
  
  
  RESULTS
  Points emphasized in the 15 recommendations include the need to share treatment decisions between the rheumatologist and the patient, the acquisition by patients of self-management skills, remission or minimal disease activity as the treatment target, the need for initiating disease-modifying drugs as early as possible, and the usefulness of regular disease activity assessments to allow rapid treatment adjustments if needed (i.e., tight disease control). First-line methotrexate monotherapy is recommended, with concomitant short-term glucocorticoid therapy if indicated by the risk/benefit ratio. Patients who fail this approach (no response after 3 months or target not achieved after 6 months) can be considered for another synthetic disease-modifying antirheumatic drug (DMARD: leflunomide or sulfasalazine), combined synthetic DMARD therapy, or methotrexate plus a biologic, depending on the prognostic factors and patient characteristics. If the first biologic fails, switching to a second biologic is recommended. In the event of a sustained remission, cautious dosage reduction of the biological and/after synthetic DMARDs is in order.
  
  
  CONCLUSIONS
  These recommendations are designed to improve the management of patients with RA.
authors.affiliation: Department of Rheumatology, Nîmes University Hospital, EA 2415, Montpellier I University, 30029 Nîmes, France. Electronic address: cecile.gaujoux.viala@chu-nimes.fr.
authors.forename: Cécile
authors.initials: C
authors.lastname: Gaujoux-Viala
authors.affiliation: Sorbonne Universities, UPMC Univ Paris 06, GRC 08, institut Pierre Louis d'épidémiologie et de santé publique; AP-HP, Department of Rheumatology, CHU Pitié-Salpetrière, 75013 Paris, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
authors.affiliation: Department of Rheumatology, Purpan Hospital, CHRU de Toulouse, Paul Sabatier Toulouse III University, UMR Inserm 1043-CNRS 5282, 31059 Toulouse, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cantagrel
authors.affiliation: Paris Descartes University - Department of Rheumatology -Cochin Hospital, Assistance Publique - Hôpitaux de Paris - INSERM (U1153): épidémiologie clinique et biostatistiques, PRES Sorbonne Paris-Cité, 75014 Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.affiliation: Sorbonne Universities, UPMC Univ Paris 06, GRC 08, institut Pierre Louis d'épidémiologie et de santé publique; AP-HP, Department of Rheumatology, CHU Pitié-Salpetrière, 75013 Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
authors.affiliation: Department of Rheumatology, Paris-Sud Universities Hospital, AP-HP, Inserm U 1012, Paris Sud University, 92276 Le Kremlin Bicêtre, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Mariette
authors.affiliation: Cabinet de rhumatologie, 78200 Mantes la Jolie, Yvelines, France.
authors.forename: Henri
authors.initials: H
authors.lastname: Nataf
authors.affiliation: Department of rheumatology, CHU de la Cavale Blanche, boulevard Tanguy-Prigent, 29609 Brest, France; EA 2216, Bretagne Occidentale University, 29200 Brest, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.affiliation: Association nationale de défense contre l'arthrite rhumatoïde (ANDAR), 75014 Paris, France.
authors.forename: Sonia
authors.initials: S
authors.lastname: Trope
authors.affiliation: Department of rheumatology, Lapeyronie Hospital, CHRU de Montpellier, Montpellier I University, UMR 5535, 34295 Montpellier, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans
keywords: Biologics; Glucocorticoid therapy; Recommendations; Rheumatoid arthritis; Treatment