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American College of Rheumatology recommendations for the treatment of RA: an issue of choices

Nature Clinical Practice Rheumatology volume 5, pages 8–9 (2009)Cite this article

On behalf of the American College of Rheumatology (ACR), Saag et al. recently published recommendations for the use of nonbiologic and biologic DMARDs in rheumatoid arthritis (RA).1 A group of experts was charged with the enormous task of bringing evidence-based clarity to the multitude of treatment options for RA and providing guidance to practicing rheumatologists. Their assignment demanded that they cover not only indications, but also domains such as screening for tuberculosis, monitoring for adverse effects and assessing clinical response, as well as the roles of cost and patient preference in decision-making. At the same time, the resulting recommendations needed to be practical, applicable to many patients, clear and unambiguous, and proven beyond reasonable scientific doubt.

First of all, the working group, the panels of rheumatologists and the ACR should be praised for their thorough search and interpretation of the literature, as well as for their attempt to amalgamate the available information. In this commentary, I will neither argue the chosen methodology for the development of the recommendations nor discuss the results of the literature search. Rather, I will comment on how other choices made by the expert group might have influenced the practicality of this document as an aid to medical decision-making.

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  1. Maastricht University Medical Center, Department of Internal Medicine/Rheumatology, PO Box 5800, 6202 AZ Maastricht, The Netherlands r.landewe@mumc.nl

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  1. RBM Landewé is Professor in Rheumatology at Maastricht University Medical Center and the Care And Public Health Research Institute, Maastricht, The Netherlands.,

    Robert BM Landewé

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Landewé, R. American College of Rheumatology recommendations for the treatment of RA: an issue of choices. Nat Rev Rheumatol 5, 8–9 (2009). https://doi.org/10.1038/ncprheum0958

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