Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • News & Views
  • Published:

Rheumatoid arthritis

Missed opportunities in the 2015 ACR guideline for RA treatment

The new ACR guideline for the treatment of rheumatoid arthritis (RA) is technically solid, but the new recommendations miss some of the most topical issues in RA therapeutics. The fact that evidence from many high-quality clinical studies in RA was not deemed sufficient to support stronger recommendations is also worrying.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

References

  1. Singh, J. A. et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. http://dx.doi.org/10.1002/art.39480 (2015).

  2. Svensson, B. et al. Low-dose prednisolone in addition to the initial disease-modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate: a two-year randomized trial. Arthritis Rheum. 52, 3360–3370 (2005).

    Article  CAS  Google Scholar 

  3. Boers, M. et al. Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet 350, 309–318 (1997).

    Article  CAS  Google Scholar 

  4. Mottonen, T. et al. Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomised trial. Lancet 353, 1568–1573 (1999).

    Article  CAS  Google Scholar 

  5. Verstappen, S. M. et al. Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA, an open-label strategy trial). Ann. Rheum. Dis. 66, 1443–1449 (2007).

    Article  CAS  Google Scholar 

  6. Hetland, M. L. et al. Combination treatment with methotrexate, cyclosporine, and intraarticular betamethasone compared with methotrexate and intraarticular betamethasone in early active rheumatoid arthritis: an investigator-initiated, multicenter, randomized, double-blind, parallel-group, placebo-controlled study. Arthritis Rheum. 54, 1401–1409 (2006).

    Article  CAS  Google Scholar 

  7. Smolen, J. S. et al. Adjustment of therapy in rheumatoid arthritis on the basis of achievement of stable low disease activity with adalimumab plus methotrexate or methotrexate alone: the randomised controlled OPTIMA trial. Lancet 383, 321–332 (2014).

    Article  CAS  Google Scholar 

  8. van Vollenhoven, R. F. et al. Tofacitinib or adalimumab versus placebo in rheumatoid arthritis. N. Engl. J. Med. 367, 508–519 (2012).

    Article  CAS  Google Scholar 

  9. van Vollenhoven, R. F. et al. Full dose, reduced dose or discontinuation of etanercept in rheumatoid arthritis. Ann. Rheum. Dis. http://dx.doi.org/10.1136/annrheumdis-2014-205726 (2015).

  10. Hambardzumyan, K. et al. Pretreatment multi-biomarker disease activity score and radiographic progression in early RA: results from the SWEFOT trial. Ann. Rheum. Dis. 74, 1102–1109 (2015).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ronald van Vollenhoven.

Ethics declarations

Competing interests

The author has received support and grants for research from AbbVie, Amgen, Bristol-Myers Squibb, GlaxoSmithKline, Pfizer, Roche and UCB, and has received consultancy honoraria from AbbVie, Biotest, Bristol-Myers Squibb, Celgene, Crescendo, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, UCB and Vertex.

Supplementary information

Supplementary Box

Topics to include in future guidelines (PDF 104 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van Vollenhoven, R. Missed opportunities in the 2015 ACR guideline for RA treatment. Nat Rev Rheumatol 12, 135–136 (2016). https://doi.org/10.1038/nrrheum.2015.181

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrrheum.2015.181

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing