- The treatment of rheumatoid arthritis (RA) is constantly evolving in line with advances in therapy and clinical evidence. Against this backdrop, the European League Against Rheumatism (EULAR) has now released updated recommendations for the treatment of RA as part of a major international initiative led by the Medical University of Vienna. The guidelines provide a refined, evidence-based framework to enable more effective, safer and more personalised treatment of patients, and were recently published in the Annals of the Rheumatic Diseases.
This large-scale initiative is based on systematic reviews of the current evidence, conducted by Victoria Konzett (MedUni Vienna) and Faidra Laskou (University of Southampton). The recommendations were developed on behalf of EULAR (European Alliance of Associations for Rheumatology) by an international working group of 50 experts led by Josef Smolen (Division of Rheumatology, Department of Medicine III, MedUni Vienna). "With this update, we aim to provide clear, evidence-based guidelines that reflect both the progress in available therapies and the complexity of today’s treatment of rheumatoid arthritis," says Smolen.
Taking individual factors into account
In recent years, the range of treatments for RA has expanded considerably and now includes conventional synthetic, biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs). The updated recommendations therefore shift the focus from the selection of individual active substances towards the optimisation of treatment strategies. A core principle remains the targeted ("treat-to-target") approach, which aims for sustained freedom from symptoms (remission) or at least low disease activity in all patients. Treatment should be started as early as possible and regularly adjusted if defined targets are not met. It is important that, when making treatment decisions, the individual characteristics, preferences and comorbidities of patients are taken into account alongside efficacy and safety considerations.
Significant clarifications have been introduced in the new guidelines regarding drug therapy: Methotrexate (MTX) remains the cornerstone of first-line therapy, whilst glucocorticoids are recommended as short-term bridging therapy. In cases of inadequate response, biological DMARDs should be used, whilst JAK inhibitors may be considered following a careful risk assessment. "In the event of sustained remission, dose reduction is now preferred to complete discontinuation in order to prevent the recurrence of disease flares," said Smolen regarding one of the key adjustments.
The best possible treatment at the right time
Rheumatoid arthritis is a chronic inflammatory disease primarily affecting the joints, from which around 18 million people worldwide are affected. Despite enormous medical advances, the varying response of patients to available treatments, for example, remains a challenge. Furthermore, a complete cure is still rare. The new guideline represents an important step towards more precise, effective and personalised care. "At the heart of this are the strategic treat-to-target approach and shared decision-making to ensure that every patient receives the best possible treatment at the right time," says Daniel Aletaha, Head of the Division of Rheumatology at MedUni Vienna, who also contributed to the publication. The new guideline underscores MedUni Vienna’s leading role in the development of international care standards in rheumatology.
Publication: Annals of the Rheumatic Diseases
EULAR recommendations for the management of rheumatoid arthritis with synthetic and biologic disease-modifying antirheumatic drugs: 2025 update
Josef S. Smolen, Christopher E Edwards, et al.
DOI: 10.1016/j.ard.2026.01.023
https://pubmed.ncbi.nlm.nih.gov/41826212/
