title: 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.
abstract: OBJECTIVE
  To develop a new evidence-based, pharmacologic treatment guideline for rheumatoid arthritis (RA).
  
  
  METHODS
  We conducted systematic reviews to synthesize the evidence for the benefits and harms of various treatment options. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence. We employed a group consensus process to grade the strength of recommendations (either strong or conditional). A strong recommendation indicates that clinicians are certain that the benefits of an intervention far outweigh the harms (or vice versa). A conditional recommendation denotes uncertainty over the balance of benefits and harms and/or more significant variability in patient values and preferences.
  
  
  RESULTS
  The guideline covers the use of traditional disease-modifying antirheumatic drugs (DMARDs), biologic agents, tofacitinib, and glucocorticoids in early (<6 months) and established (≥6 months) RA. In addition, it provides recommendations on using a treat-to-target approach, tapering and discontinuing medications, and the use of biologic agents and DMARDs in patients with hepatitis, congestive heart failure, malignancy, and serious infections. The guideline addresses the use of vaccines in patients starting/receiving DMARDs or biologic agents, screening for tuberculosis in patients starting/receiving biologic agents or tofacitinib, and laboratory monitoring for traditional DMARDs. The guideline includes 74 recommendations: 23% are strong and 77% are conditional.
  
  
  CONCLUSIONS
  This RA guideline should serve as a tool for clinicians and patients (our two target audiences) for pharmacologic treatment decisions in commonly encountered clinical situations. These recommendations are not prescriptive, and the treatment decisions should be made by physicians and patients through a shared decision-making process taking into account patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Saag
authors.affiliation: University of Alabama at Birmingham.
authors.forename: S Louis
authors.initials: SL
authors.lastname: Bridges
authors.affiliation: American University of Beirut, Beirut, Lebanon, and McMaster University, Hamilton, Ontario, Canada.
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.affiliation: Tufts Medical Center, Boston, Massachusetts.
authors.forename: Raveendhara R
authors.initials: RR
authors.lastname: Bannuru
authors.affiliation: Tufts Medical Center, Boston, Massachusetts.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Sullivan
authors.affiliation: Tufts Medical Center, Boston, Massachusetts.
authors.forename: Elizaveta
authors.initials: E
authors.lastname: Vaysbrot
authors.affiliation: Tufts Medical Center, Boston, Massachusetts.
authors.forename: Christine
authors.initials: C
authors.lastname: McNaughton
authors.affiliation: Tufts Medical Center, Boston, Massachusetts.
authors.forename: Mikala
authors.initials: M
authors.lastname: Osani
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Shmerling
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.affiliation: University of California, Los Angeles.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Furst
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Deborah
authors.initials: D
authors.lastname: Parks
authors.affiliation: University of California, San Diego.
authors.forename: Arthur
authors.initials: A
authors.lastname: Kavanaugh
authors.affiliation: University of Nebraska Medical Center, Omaha.
authors.forename: James
authors.initials: J
authors.lastname: O'Dell
authors.affiliation: North Mississippi Medical Center, Tupelo.
authors.forename: Charles
authors.initials: C
authors.lastname: King
authors.affiliation: Healthy Motivation, Santa Barbara, California.
authors.forename: Amye
authors.initials: A
authors.lastname: Leong
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Matteson
authors.affiliation: University of Minnesota and Park Nicollet Clinic, St. Louis Park.
authors.forename: John T
authors.initials: JT
authors.lastname: Schousboe
authors.affiliation: NorthShore University Health System, Evanston, Illinois.
authors.forename: Barbara
authors.initials: B
authors.lastname: Drevlow
authors.affiliation: Global Healthy Living Foundation, New York, New York.
authors.forename: Seth
authors.initials: S
authors.lastname: Ginsberg
authors.affiliation: NorthShore University Health System, Evanston, Illinois.
authors.forename: James
authors.initials: J
authors.lastname: Grober
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: E William
authors.initials: EW
authors.lastname: St Clair
authors.affiliation: Rheumatology Consultants of Oregon, West Linn.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tindall
authors.affiliation: American College of Rheumatology, Atlanta, Georgia.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Miller
authors.affiliation: Tufts Medical Center, Boston, Massachusetts.
authors.forename: Timothy
authors.initials: T
authors.lastname: McAlindon
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D012955:Societies, Medical; D014481:United States
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D005938:Glucocorticoids