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

From: Poor prognostic factors guiding treatment decisions in rheumatoid arthritis patients: a review of data from randomized clinical trials and cohort studies

  RA state Poor prognostic factors Presence allows for Treatment target
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
  1. ACPA anti-citrullinated protein-peptide antibodies, ACR American College of Rheumatology, CRP C-reactive protein, ESR erythrocyte sedimentation rate, EULAR European League Against Rheumatism, DAS disease activity score, bDMARD biologic disease-modifying antirheumatic drug, csDMARD conventional synthetic disease-modifying antirheumatic drug, RA rheumatoid arthritis, RF rheumatoid factor