Table 3 Treatment recommendations with poor prognostic factors as decision-criteria

EULAR [3]

RA, first DMARD failure

High disease activity, RF/ACPA positivity, early presence of joint damage

bDMARDs

Low disease activity or remission

ACR [4]

Early RA <6 months

Moderate disease activity + ≥1 of functional limitation, extraarticular disease, RF/ACPA positivity, erosions

csDMARD combination

High disease activity + one or more of functional limitation, extra-articular disease, RF/ACPA positivity, erosions

bDMARD or csDMARD combination

Established RA (≥6 months or 1987 ACR criteria)

LDA + one or more of functional limitation, extraarticular disease, RF/ACPA positivity, erosions or at least moderate disease activity

csDMARD combination, bDMARD at 3 months

Italy [5]

RA, DMARD failure

1. High disease activity (DAS28 > 5.1 for ≥1 months

2. Moderate disease activity (DAS >3.2) + ACPA/RF positive and elevated CRP or ESR, persistence of one or more swollen joint, bone erosions on X-rays, active synovitis with power Doppler signal

3. New erosions

bDMARD

France [35]

RA, DMARD failure

Existence or progression of structural damage, high clinical and/or laboratory activity, high RF/ACPA titers

bDMARD

Germany [34]

RA, 1st DMARD failure

High disease activity, RF/ACPA positivity, early presence of joint damage

bDMARD

Canada [36]

RA

Not further specified

Initial csDMARD combination