Aim: To update recommendations based on current best evidence concerning the treatment of rheumatoid arthritis (RA), focusing particularly on the role of targeted therapies, to inform clinicians on new developments that will impact their current practice. — Joint pain, stiffness and swelling for more than 6 weeks 2. Rheumatoid arthritis, anti-tumour necrosis factor therapy, and risk of malignant melanoma: nationwide population based prospective cohort study from Sweden. Park EJ, Kim H, Jung SM, Sung YK, Baek HJ, Lee J. Korean J Intern Med. 2010;69(9):1580–1588. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Verhoeven AC, 4  TEMPO (Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes) study investigators. Keystone EC, Neogi T, †—Nonbiologic drugs listed in approximate order of priority. Silman AJ, Maneiro JR, McMurray JJ, 17. Klareskog L, Both rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) are associated with poor radiologic outcomes in patients with rheumatoid arthritis (RA). England BR, Michaud K, Park SH, FitzGerald O, J Rheumatol. The incidence of cancer in patients with rheumatoid arthritis and a prior malignancy who receive TNF inhibitors or rituximab: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. et al. Additional disease-modifying antirheumatic drugs or biologic agents should be added if disease activity persists. et al. Rheumatoid arthritis is the most commonly diagnosed systemic inflammatory arthritis, with a life- time prevalence of up to 1% worldwide. Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune disease that primarily affects the joints and is associated with autoantibodies that target various molecules including modified self-epitopes. 2016;352:i262. Combe B, 14. Efficacy of methotrexate and etanercept biosimilar rhTNFR:Fc in Chinese patients with active rheumatoid arthritis: A controlled, randomized and multicenter study. Raaschou P, Epub 2019 Feb 28. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. ‡—Cost of a single dose; typically infused in a hospital setting. Recommendations 1-3 deal with the use of conventional synthetic disease-modifying antirheumatic drugs. ... Every patient suffering from active rheumatoid arthritis should be treated with disease-modifying antirheumatic drugs (DMARD) but methotrexate initially remains the first choice treatment. Clinical, functional, and radiographic implications of time to treatment response in patients with early rheumatoid arthritis: a posthoc analysis of the PREMIER study. ; ‡—Although patients with a score of less than 6 out of 10 are not classifiable as having RA, their status can be reassessed, and the criteria might be fulfilled cumulatively over time. Large multicenter prospective cohorts of patients with new-onset inflammatory arthritis have shown female predominance (77% of patients in cohort).7 The mean age at onset was 48 years, and patients had an average of seven swollen and eight tender joints.7 The C-reactive protein level was elevated in 39% of patients, 44% had elevated immunoglobulin M (IgM) rheumatoid factor, and 39% had anti-citrullinated protein antibody.7 An international cohort with early RA reported similar percentages of females, rheumatoid factor, and anti-citrullinated protein antibody positivity.8 Clinical trials including more patients with long-standing RA found higher rates of positive rheumatoid factor and anti-citrullinated protein antibody (close to 90%).9,10. Am Fam Physician.