EULAR recommendations for the management of rheumatoid arthritis with synthetic and biologic disease-modifying antirheumatic drugs: 2025 update - PubMed
7 hours ago
- #DMARDs
- #EULAR recommendations
- #rheumatoid arthritis
- The 2025 EULAR update provides revised recommendations for managing rheumatoid arthritis (RA) with synthetic and biologic disease-modifying antirheumatic drugs (DMARDs).
- Five overarching principles and nine recommendations were agreed upon, covering conventional synthetic DMARDs (e.g., methotrexate, leflunomide), glucocorticoids, biologic DMARDs (e.g., TNF inhibitors, abatacept), and targeted synthetic DMARDs (JAK inhibitors).
- Initial treatment should ideally include methotrexate (MTX) combined with short-term glucocorticoids. If response is insufficient after 3-6 months, a biologic DMARD or JAK inhibitor (with risk assessment) should be added.
- Safety considerations include risks of major cardiovascular events (MACEs), malignancies, and thromboembolic events, especially with JAK inhibitors.
- In case of treatment failure with the first biologic or JAK inhibitor, switching to another biologic (same or different class) or JAK inhibitor is recommended.
- Tapering DMARDs may be considered during sustained remission, but stopping treatment often leads to disease flare.
- Levels of evidence and agreement were high for most recommendations, reflecting strong consensus.
- The update emphasizes efficacy, safety, and cost considerations in RA management.