EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update

doi:10.1136/annrheumdis-2019-216655

Practice Guideline

. 2020 Jun;79(6):685-699.

doi: 10.1136/annrheumdis-2019-216655. Epub 2020 Jan 22.

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update

Josef S Smolen^#¹, Robert B M Landewé^#^{2

3}, Johannes W J Bijlsma⁴, Gerd R Burmester⁵, Maxime Dougados⁶, Andreas Kerschbaumer⁷, Iain B McInnes⁸, Alexandre Sepriano⁹, Ronald F van Vollenhoven¹⁰, Maarten de Wit¹¹, Daniel Aletaha⁷, Martin Aringer¹², John Askling¹³, Alejandro Balsa¹⁴, Maarten Boers¹⁵, Alfons A den Broeder¹⁶, Maya H Buch¹⁷, Frank Buttgereit⁵, Roberto Caporali¹⁸, Mario Humberto Cardiel¹⁹, Diederik De Cock²⁰, Catalin Codreanu²¹, Maurizio Cutolo²², Christopher John Edwards²³, Yvonne van Eijk-Hustings²⁴, Paul Emery²⁵, Axel Finckh²⁶, Laure Gossec²⁷, Jacques-Eric Gottenberg²⁸, Merete Lund Hetland²⁹, Tom W J Huizinga³⁰, Marios Koloumas^{31

32}, Zhanguo Li³³, Xavier Mariette³⁴, Ulf Müller-Ladner³⁵, Eduardo F Mysler³⁶, Jose A P da Silva³⁷, Gyula Poór³⁸, Janet E Pope³⁹, Andrea Rubbert-Roth⁴⁰, Adeline Ruyssen-Witrand⁴¹, Kenneth G Saag⁴², Anja Strangfeld⁴³, Tsutomu Takeuchi⁴⁴, Marieke Voshaar⁴⁵, René Westhovens²⁰, Désirée van der Heijde³⁰

Affiliations

¹ Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria josef.smolen@meduniwien.ac.at.
² Amsterdam University Medical Center, Amsterdam, The Netherlands.
³ Zuyderland Medical Center, Heerlen, The Netherlands.
⁴ Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁵ Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany.
⁶ Rhumatologie B, Hopital Cochin, 27 rue du Fbg Saint-Jacques, Paris, France.
⁷ Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
⁸ Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
⁹ NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal, and Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
¹⁰ Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
¹¹ EULAR Patient Research Partner; Department Medical Humanities, Amsterdam University Medical Center, Amsterdam, The Netherlands.
¹² Division of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus, Dresden, Germany.
¹³ Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
¹⁴ Servicio de Reumatologia Hospital Universitario La Paz, Instituto de Investigacion IdiPAZ, Madrid, Spain.
¹⁵ Department of Epidemiology and Biostatistics and Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
¹⁶ Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
¹⁷ Division of Musculoskeletal and Dermatological Sciences, University of Manchester; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.
¹⁸ Department of Clinical Sciences and Community Health, University of Milan, and IRCCS S Matteo Foundation, Pavia, Italy.
¹⁹ Centro de Investigación Clínica de Morelia SC, Morelia, Michoacán, Mexico.
²⁰ Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven; Rheumatology, University Hospitals Leuven, Leuven, Belgium.
²¹ Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania.
²² Research Laboratory and Division of Clinical Rheumatology, Department of Internal Medicine - University of Genoa, Genoa, Italy.
²³ Musculoskeletal Research Unit, NIHR Clinical Research Facility, University Hospital Southampton, Southampton, UK.
²⁴ Department of Patient & Care and Department of Rheumatology, University of Maastricht, Maastricht, The Netherlands.
²⁵ NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
²⁶ Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland.
²⁷ Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris and Pitié Salpêtrière hospital, AP-HP, Rheumatology Department, Paris, France.
²⁸ Strasbourg University Hospital and University of Strasbourg, CNRS, Institut de Biologie Moléculaire et Cellulaire, Immunopathologie, et Chimie Thérapeutique, Strasbourg, France.
²⁹ Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
³⁰ Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
³¹ European League Against Rheumatism, Zurich, Switzerland.
³² Cyprus League against Rheumatism, Nikosia, Cyprus.
³³ Department of Rheumatology and Immunology, Beijing University People's Hospital, Beijing, China.
³⁴ Université Paris-Sud, AP-HP, Université Paris-Saclay, Le Kremlin Bicêtre, France.
³⁵ Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig University Giessen, Bad Nauheim, Germany.
³⁶ Organización Médica de Investigación, Buenos Aires, Argentina.
³⁷ Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra Praceta Mota Pinto, and Coimbra Institute for Clinical and Biomedical Research (i-CRB), Faculty of Medicine of Coimbra, Coimbra, Portugal.
³⁸ National Institute of Rheumatology & Physiology, Semmelweis University, Budapest, Hungary.
³⁹ University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Medicine, London, Ontario, Canada.
⁴⁰ Klinik für Rheumatologie, Kantonsspital St Gallen, St Gallen, Switzerland.
⁴¹ UMR 1027, Inserm, Université Paul Sabatier Toulouse III, Toulouse, France.
⁴² Department of Medicine, Division of Rheumatology, University of Alabama at Birmingham, Brmingham, Alabama, USA.
⁴³ Programme Area Epidemiology, Deutsches Rheumaforschungszentrum Berlin, Berlin, Germany.
⁴⁴ Keio University School of Medicine, Keio University Hospital, Tokyo, Japan.
⁴⁵ Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.

^# Contributed equally.

PMID: 31969328
DOI: 10.1136/annrheumdis-2019-216655

Free article

Practice Guideline

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update

Josef S Smolen et al. Ann Rheum Dis. 2020 Jun.

Free article

. 2020 Jun;79(6):685-699.

doi: 10.1136/annrheumdis-2019-216655. Epub 2020 Jan 22.

Authors

Affiliations

¹ Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria josef.smolen@meduniwien.ac.at.
² Amsterdam University Medical Center, Amsterdam, The Netherlands.
³ Zuyderland Medical Center, Heerlen, The Netherlands.
⁴ Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁵ Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany.
⁶ Rhumatologie B, Hopital Cochin, 27 rue du Fbg Saint-Jacques, Paris, France.
⁷ Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
⁸ Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
⁹ NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal, and Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
¹⁰ Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
¹¹ EULAR Patient Research Partner; Department Medical Humanities, Amsterdam University Medical Center, Amsterdam, The Netherlands.
¹² Division of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus, Dresden, Germany.
¹³ Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
¹⁴ Servicio de Reumatologia Hospital Universitario La Paz, Instituto de Investigacion IdiPAZ, Madrid, Spain.
¹⁵ Department of Epidemiology and Biostatistics and Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
¹⁶ Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
¹⁷ Division of Musculoskeletal and Dermatological Sciences, University of Manchester; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.
¹⁸ Department of Clinical Sciences and Community Health, University of Milan, and IRCCS S Matteo Foundation, Pavia, Italy.
¹⁹ Centro de Investigación Clínica de Morelia SC, Morelia, Michoacán, Mexico.
²⁰ Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven; Rheumatology, University Hospitals Leuven, Leuven, Belgium.
²¹ Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania.
²² Research Laboratory and Division of Clinical Rheumatology, Department of Internal Medicine - University of Genoa, Genoa, Italy.
²³ Musculoskeletal Research Unit, NIHR Clinical Research Facility, University Hospital Southampton, Southampton, UK.
²⁴ Department of Patient & Care and Department of Rheumatology, University of Maastricht, Maastricht, The Netherlands.
²⁵ NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
²⁶ Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland.
²⁷ Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris and Pitié Salpêtrière hospital, AP-HP, Rheumatology Department, Paris, France.
²⁸ Strasbourg University Hospital and University of Strasbourg, CNRS, Institut de Biologie Moléculaire et Cellulaire, Immunopathologie, et Chimie Thérapeutique, Strasbourg, France.
²⁹ Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
³⁰ Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
³¹ European League Against Rheumatism, Zurich, Switzerland.
³² Cyprus League against Rheumatism, Nikosia, Cyprus.
³³ Department of Rheumatology and Immunology, Beijing University People's Hospital, Beijing, China.
³⁴ Université Paris-Sud, AP-HP, Université Paris-Saclay, Le Kremlin Bicêtre, France.
³⁵ Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig University Giessen, Bad Nauheim, Germany.
³⁶ Organización Médica de Investigación, Buenos Aires, Argentina.
³⁷ Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra Praceta Mota Pinto, and Coimbra Institute for Clinical and Biomedical Research (i-CRB), Faculty of Medicine of Coimbra, Coimbra, Portugal.
³⁸ National Institute of Rheumatology & Physiology, Semmelweis University, Budapest, Hungary.
³⁹ University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Medicine, London, Ontario, Canada.
⁴⁰ Klinik für Rheumatologie, Kantonsspital St Gallen, St Gallen, Switzerland.
⁴¹ UMR 1027, Inserm, Université Paul Sabatier Toulouse III, Toulouse, France.
⁴² Department of Medicine, Division of Rheumatology, University of Alabama at Birmingham, Brmingham, Alabama, USA.
⁴³ Programme Area Epidemiology, Deutsches Rheumaforschungszentrum Berlin, Berlin, Germany.
⁴⁴ Keio University School of Medicine, Keio University Hospital, Tokyo, Japan.
⁴⁵ Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.

^# Contributed equally.

PMID: 31969328
DOI: 10.1136/annrheumdis-2019-216655

Abstract

Objectives: To provide an update of the European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) management recommendations to account for the most recent developments in the field.

Methods: An international task force considered new evidence supporting or contradicting previous recommendations and novel therapies and strategic insights based on two systematic literature searches on efficacy and safety of disease-modifying antirheumatic drugs (DMARDs) since the last update (2016) until 2019. A predefined voting process was applied, current levels of evidence and strengths of recommendation were assigned and participants ultimately voted independently on their level of agreement with each of the items.

Results: The task force agreed on 5 overarching principles and 12 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GCs); biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, sarilumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (the Janus kinase (JAK) inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib). Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering on sustained clinical remission is provided. Cost and sequencing of b/tsDMARDs are addressed. Initially, MTX plus GCs and upon insufficient response to this therapy within 3 to 6 months, stratification according to risk factors is recommended. With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD or JAK inhibitor should be added to the csDMARD. If this fails, any other bDMARD (from another or the same class) or tsDMARD is recommended. On sustained remission, DMARDs may be tapered, but not be stopped. Levels of evidence and levels of agreement were mostly high.

Conclusions: These updated EULAR recommendations provide consensus on the management of RA with respect to benefit, safety, preferences and cost.

Keywords: DMARDs (biologic); DMARDs (synthetic); economic evaluations; rheumatoid arthritis; treatment.

PubMed Disclaimer

Conflict of interest statement

Competing interests: DA: grants from Abbvie, Novartis, Roche and honoraria from Abbvie, Amgen, Celgene, Lilly, Medac, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi/Genzyme; MA: honoraria from AbbVie, Astra Zeneca, BMS, Boehringer Ingelheim, Chugai, HEXAL, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB; JA: grants from Abbvie, BMS, Lilly, Merck, Pfizer, Roche, Samsung Bioepis, UCB; AB: grants from Pfizer, Bristol-Myers Squibb and honoraria from Pfizer, Roche, AbbVie, Bristol-Myers Squibb, UCB, MSD, Novartis, Sanofi, Biogen, Sandoz, Celltrion, Nordic, Gilead; JWJB: honoraria from Lilly, Roche, Sanofi; MB: honoraria from BMS, Teva, Novartis, Pfizer, GSK; AdB: grants from Abbvie, Biogen, Celltrion and honoraria from Abbvie, Biogen, Boehringer-Ingelheim, Celgene, Fresenius, MSD, Roche.MHB has received grants from Pfizer, Roche and UCB and consulting fees from Abbvie, Eli-Lilly, Merck.Serono, Pfizer, Sandoz, Sanofi; GB: grants from Abbvie, Pfizer, Sanofi, UCB and honoraria from Abbvie, Celgene, Gilead, Lilly, MSD, Novartis, Pfizer, Sanofi, Roche. FB: grants from Abbvie, BMS, Horizon, Medac, Pfizer, Roche, Lilly, Sanofi and honoraria from Abbvie, Galapagos, Horizon, Medac, Pfizer, Roche, Sanofi, Janssen, BMS, MSD, Lilly; RC: honoraria from Abbvie, BMS, Celgene, Celltrion, Gilead, Janssen, Lilly MSD, Mundipharma, Novartis-Sandoz, Pfizer, Roche, Sanofi and UCB; MC; honoraria from Abbvie, Astellas, BMS, Lilly, Pfizer and Roche; DDC: no conflict; CC: honoraria from AbbVie, Accord Healthcare, Alfasigma, Berlin Chemie, Egis, Eli Lilly, Ewopharma, Genesis, MSD, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB; MD: grants from Pfizer, Abbvie, UCB, Janssen, Novartis and honoraria from Pfizer, Abbvie, UCB, Janssen, MSD, Novartis, BMS, Celgene, Biogen, Sandoz; CJE: grants from Abbvie, Biogen and honoraria from Abbvie, BMS, Biogen, Celgene, Fresenius, Gilead, Janssen, Lilly, Mundipharma, Pfizer, MSD, Novartis, Roche, Samsung, Sanofi, UCB; PE: grants from AbbVie, Novartis, Samsung, Lilly and honoraria from AbbVie, Novartis, BMS, Gilead, Samsung, Lilly; AF: grants from BMS, Pfizer and honoraria from AB2 BIO, Abbvie, BMS, Lilly, MSD, Pfizer, Roche, Sanofi; LG: grants from Abbvie, BMS, Lilly, UCB and honoraria from Abbvie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sanofi-Aventis, UCB; J-EG: grants from BMS, Pfizer and honoraria from Abbvie, BMS, Lilly, Sanofi-Genzyme, Roche, UCB; MLH: grants from Abbvie, Biogen, BMS, Celltrion, MSD, Novartis, Orion, Pfizer, Samsung, UCB; TH: grants from Lilly, Merck, UCB, BMS, Janssen, Pfizer, Sanofi-Aventis, Galapagos, Boeringher and honoraria from Abblynx, BMS, Janssen, Pfizer, Sanofi-Aventis, Crescendo Bioscience, Galapagos, Lilly; AK: honoraria from BMS, Pfizer, Celgene, MSD; MK: no conflicts of interest; RBML: honoraria from AbbVie, BMS, Celgene, Eli-Lilly, Jansen Pharmaceuticals, Galapagos, Novartis, MSD, Pfizer, UCB and Director of Rheumatology Consultancy BV; XM: honoraria from BMS, Gilead, Pfizer, Samsung, UCB; IBM: grants from Astra Zeneca, UCB, BMS, Janssen, GSK, Compugen, Boehringer, Celgene and honoraria from Abbvie, BMS, Janssen, Novartis, UCB, Astra Zeneca, Celgene, Causeway, Lilly, Leo, Novimmune; EM: grants from Pfizer, Lilly, BMS, AbbVie, GSK, Astra and honoraria from Pfizer, BMS, Roche, Lilly, AbbVie, Gemma, Sanofi; TWJH: grants from Eli Lilly, Merck, UCB, BMS, Janssen, Pfizer, Sanofi-Aventis, Galapagos, Boehringer and honoraria from Abblynx, Abbvie, BMS, Boehringer, Crescendo-Bioscience, Epirus, Galapagos, Janssen, Lilly, Merck, Novartis, Nycomed, Pfizer, Roche, Sanofi-Aventis, Takeda, UCB; ZL: no conflicts of interest; UM-L: honoraria from Abbvie, BMS, MSD, Chugai, Roche, Pfizer, Sanofi, Boehringer, Actelion, Medac, Lilly; GP: no conflicts of interest; JP: grants from BMS, Merck, UCB and honoraria from AbbVie, Actelion, Amgen, BMS, Bayer, GSK, Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB; AR-R: honoraria from Abbvie, Chugai, BMS, Sanofi, Roche, Lilly, Janssen, Novartis, Celgene, MSD, UCB; AR-W: grants from Pfizer, Abbvie and honoraria from Abbvie, Amgen, BMS, Janssen, Lilly, Medac, Nordic Pharma, Novartis, Pfizer, Roche-Chugai, Sanofi, UCB; KS: grants from Amgen, Ironwood/AstraZeneca, Horizon, SOBI, Takeda and honoraria from AbbVie, Amgen, Ironwood/AstraZeneca, Bayer, Gilead, Horizon, Kowa, Radius, Roche/Genentech, SOBI, Takeda, Teijin; MSV: no conflicts of interest. AS: honoraria from Novartis; JSS: grants from Abbvie, AstraZeneca, Janssen, Lilly, Novartis, Roche and honoraria from Abbvie, Amgen, AstraZeneca, Astro, BMS, Celgene, Celltrion, Chugai, Gilead, ILTOO, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Roche, Samsung, Sanofi, UCB; AS: grants from AbbVie, Bristol-Myers Squibb, Celltrion, Hexal AG Lilly, MSD Sharp & Dome, Pfizer, Roche, Samsung Bioepis, Sanofi-Aventis, UCB and honoraria from AbbVie, BMS, MSD, Pfizer, Roche; TT: grants from AbbVie, Asahikasei, Astellas, AYUMI, Chugai, Daiichi Sankyo, Eisai, Mitsubishi Tanabe, Nipponkayaku, Novartis, Pfizer, Takeda and honoraria from AbbVie, Astellas, Astra Zeneca, BMS, Chugai, Diaichi Sankyo, Eisai, Eli Lilly, GlaxoSmithKline, Janssen, Mitsubishi Tanabe, Nipponkayaku, Novartis, Pfizer, Sanofi, Teijin, Taiho Pharmaceutical, Taisho Pharmaceutical, Takeda, UCB; DvdH: grants from UCB and honoraria from AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB and Director Imaging Rheumatology BV; YvE-H: honoraria from Celgene; RFvV: grants from BMS, GSK, Lilly, UCB and honoraria from AbbVie, AstraZeneca, Biotest, BMS, Celgene, GSK, Janssen, Lilly, Novartis, Pfizer, Roche, UCB; RW: grants from Roche, BMS and honoraria from Celltrion, Galapagos-Gilead; MdW: honoraria from 'Stichting Tools', Janssen-Cilag.

Comment in

EULAR updates its RA management recommendations.
Onuora S. Onuora S. Nat Rev Rheumatol. 2020 Mar;16(3):128. doi: 10.1038/s41584-020-0385-5. Nat Rev Rheumatol. 2020. PMID: 32001826 No abstract available.

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EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update

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EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update

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