Skip to main content

Advertisement

SpringerLink
Log in

Treatment Guidelines in Rheumatoid Arthritis—Optimizing the Best of Both Worlds

  • Rheumatoid Arthritis (Y Yazici, Section Editor)
  • Published:
Current Treatment Options in Rheumatology Aims and scope Submit manuscript

Abstract

Purpose of review

Rheumatoid arthritis (RA) leads to significant joint damage and systemic complications. Available treatment options for RA has made it possible to achieve a good control over disease activity and improve patient outcomes. In this review, we discuss management guidelines for RA and their practical application by discussing clinical scenarios commonly encountered in rheumatology practice.

Recent findings

European League Against Rheumatism recently updated treatment recommendations for management of RA. The general fundamentals of these recommendations are similar to those of the 2015 American College of Rheumatology guidelines for the treatment of RA but with some key distinctions. We discuss three RA cases to illustrate key aspects of treatment guidelines. New data show increased cardiovascular risk in patients with RA that is possibly related to associated systemic inflammation.

Summary

While several questions about RA remain unanswered, the clinical outcomes have improved in recent years. A strategic approach to manage RA is recommended which involves early diagnosis and treatment and escalating treatments to achieve a therapeutic target. In addition to treating RA disease activity, management of comorbid conditions is imperative to prevent long-term systemic damage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

RA:

rheumatoid arthritis

ACR:

American College of Rheumatology

EULAR:

European League Against Rheumatism

CDAI:

Clinical Disease Activity Index

SDAI:

Simple Disease Activity Index

DAS:

disease activity score

NSAIDs:

non-steroidal anti-inflammatory drugs

csDMARDs:

conventional synthetic disease modifying anti-rheumatic drugs

tsDMARDs:

targeted synthetic DMARDs

JAK:

Janus kinase

bDMARDs:

biologic DMARDs

RCT:

randomized controlled trial

NMA:

network meta-analysis

UAB:

University of Alabama at Birmingham

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, van Zeben D, Kerstens PJ, Hazes JM, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum. 2005;52(11):3381–90.

    CAS  PubMed  Google Scholar 

  2. Anderson J, Caplan L, Yazdany J, Robbins ML, Neogi T, Michaud K, et al. Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res. 2012;64(5):640–7.

    Google Scholar 

  3. • Singh JA, Saag KG, Bridges SL Jr, Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheum. 2016;68(1):1–26 Guideline for the Treatment of Rheumatoid Arthritis by the American College of Rheumatology.

    Google Scholar 

  4. •• Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020. 2019 update of the European League Against Rheumatism) rheumatoid arthritis management recommendations.

  5. Furer V, Rondaan C, Heijstek MW, Agmon-Levin N, van Assen S, Bijl M, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020;79(1):39–52.

    CAS  PubMed  Google Scholar 

  6. Aletaha D, Smolen JS. Diagnosis and management of rheumatoid arthritis: a review. JAMA. 2018;320(13):1360–72.

    PubMed  Google Scholar 

  7. Plant MJ, Jones PW, Saklatvala J, Ollier WE, Dawes PT. Patterns of radiological progression in early rheumatoid arthritis: results of an 8 year prospective study. J Rheumatol. 1998;25(3):417–26.

    CAS  PubMed  Google Scholar 

  8. van Nies JA, Krabben A, Schoones JW, Huizinga TW, Kloppenburg M, van der Helm-van Mil AH. What is the evidence for the presence of a therapeutic window of opportunity in rheumatoid arthritis? A systematic literature review. Ann Rheum Dis. 2014;73(5):861–70.

    PubMed  Google Scholar 

  9. Aletaha D, Funovits J, Keystone EC, Smolen JS. Disease activity early in the course of treatment predicts response to therapy after one year in rheumatoid arthritis patients. Arthritis Rheum. 2007;56(10):3226–35.

    CAS  PubMed  Google Scholar 

  10. van Dongen H, van Aken J, Lard LR, Visser K, Ronday HK, Hulsmans HM, et al. Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis: a double-blind, randomized, placebo-controlled trial. Arthritis Rheum. 2007;56(5):1424–32.

    PubMed  Google Scholar 

  11. Genovese MC, Bathon JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH, et al. Etanercept versus methotrexate in patients with early rheumatoid arthritis: two-year radiographic and clinical outcomes. Arthritis Rheum. 2002;46(6):1443–50.

    CAS  PubMed  Google Scholar 

  12. Hazlewood GS, Barnabe C, Tomlinson G, Marshall D, Devoe DJ, Bombardier C. Methotrexate monotherapy and methotrexate combination therapy with traditional and biologic disease modifying anti-rheumatic drugs for rheumatoid arthritis: a network meta-analysis. Cochrane Database Syst Rev. 2016;8:CD010227.

    Google Scholar 

  13. Breedveld FC, Weisman MH, Kavanaugh AF, Cohen SB, Pavelka K, van Vollenhoven R, et al. The PREMIER study: a multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum. 2006;54(1):26–37.

    CAS  PubMed  Google Scholar 

  14. Emery P, Breedveld FC, Hall S, Durez P, Chang DJ, Robertson D, et al. Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial. Lancet. 2008;372(9636):375–82.

    CAS  PubMed  Google Scholar 

  15. Moreland LW, O’Dell JR, Paulus HE, Curtis JR, Bathon JM, St Clair EW, et al. A randomized comparative effectiveness study of oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis: the treatment of Early Aggressive Rheumatoid Arthritis Trial. Arthritis Rheum. 2012;64(9):2824–35.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Verschueren P, De Cock D, Corluy L, Joos R, Langenaken C, Taelman V, et al. Methotrexate in combination with other DMARDs is not superior to methotrexate alone for remission induction with moderate-to-high-dose glucocorticoid bridging in early rheumatoid arthritis after 16 weeks of treatment: the CareRA trial. Ann Rheum Dis. 2015;74(1):27–34.

    CAS  PubMed  Google Scholar 

  17. Shea B, Swinden MV, Tanjong Ghogomu E, Ortiz Z, Katchamart W, Rader T, et al. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. Cochrane Database Syst Rev. 2013;5:CD000951.

    Google Scholar 

  18. O’Dell JR, Mikuls TR, Taylor TH, Ahluwalia V, Brophy M, Warren SR, et al. Therapies for active rheumatoid arthritis after methotrexate failure. N Engl J Med. 2013;369(4):307–18.

    PubMed  Google Scholar 

  19. Erhardt DP, Cannon GW, Teng CC, Mikuls TR, Curtis JR, Sauer BC. Low persistence rates in patients with rheumatoid arthritis treated with triple therapy and adverse drug events associated with sulfasalazine. Arthritis Care Res. 2019;71(10):1326–35.

    CAS  Google Scholar 

  20. Curtis JR, Palmer JL, Reed GW, Greenberg J, Pappas DA, Harrold LR, et al. Real-world outcomes associated with triple therapy versus TNFi/MTX therapy. Arthritis Care Res (Hoboken). 2020.

  21. Bonafede M, Johnson BH, Tang DH, Shah N, Harrison DJ, Collier DH. Etanercept-methotrexate combination therapy initiators have greater adherence and persistence than triple therapy initiators with rheumatoid arthritis. Arthritis Care Res. 2015;67(12):1656–63.

    CAS  Google Scholar 

  22. Alemao E, Litman HJ, Connolly SE, Kelly S, Hua W, Rosenblatt L, et al. Do poor prognostic factors in rheumatoid arthritis affect treatment choices and outcomes? Analysis of a US rheumatoid arthritis registry. J Rheumatol. 2018;45(10):1353–60.

    PubMed  Google Scholar 

  23. Jani M, Barton A, Warren RB, Griffiths CE, Chinoy H. The role of DMARDs in reducing the immunogenicity of TNF inhibitors in chronic inflammatory diseases. Rheumatology (Oxford). 2014;53(2):213–22.

    CAS  Google Scholar 

  24. Klareskog L, van der Heijde D, de Jager JP, Gough A, Kalden J, Malaise M, et al. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet. 2004;363(9410):675–81.

    CAS  PubMed  Google Scholar 

  25. Westhovens R, Robles M, Ximenes AC, Nayiager S, Wollenhaupt J, Durez P, et al. Clinical efficacy and safety of abatacept in methotrexate-naive patients with early rheumatoid arthritis and poor prognostic factors. Ann Rheum Dis. 2009;68(12):1870–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Emery P, Burmester GR, Bykerk VP, Combe BG, Furst DE, Barré E, et al. Evaluating drug-free remission with abatacept in early rheumatoid arthritis: results from the phase 3b, multicentre, randomised, active-controlled AVERT study of 24 months, with a 12-month, double-blind treatment period. Ann Rheum Dis. 2015;74(1):19–26.

    CAS  PubMed  Google Scholar 

  27. Atsumi T, Yamamoto K, Takeuchi T, Yamanaka H, Ishiguro N, Tanaka Y, et al. The first double-blind, randomised, parallel-group certolizumab pegol study in methotrexate-naive early rheumatoid arthritis patients with poor prognostic factors, C-OPERA, shows inhibition of radiographic progression. Ann Rheum Dis. 2016;75(1):75–83.

    CAS  PubMed  Google Scholar 

  28. Burmester GR, Rigby WF, van Vollenhoven RF, Kay J, Rubbert-Roth A, Kelman A, et al. Tocilizumab in early progressive rheumatoid arthritis: FUNCTION, a randomised controlled trial. Ann Rheum Dis. 2016;75(6):1081–91.

    CAS  PubMed  Google Scholar 

  29. Emery P, Sebba A, Huizinga TW. Biologic and oral disease-modifying antirheumatic drug monotherapy in rheumatoid arthritis. Ann Rheum Dis. 2013;72(12):1897–904.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Gabay C, Emery P, van Vollenhoven R, Dikranian A, Alten R, Pavelka K, et al. Tocilizumab monotherapy versus adalimumab monotherapy for treatment of rheumatoid arthritis (ADACTA): a randomised, double-blind, controlled phase 4 trial. Lancet. 2013;381(9877):1541–50.

    CAS  PubMed  Google Scholar 

  31. Buckley F, Finckh A, Huizinga TW, Dejonckheere F, Jansen JP. Comparative efficacy of novel DMARDs as monotherapy and in combination with methotrexate in rheumatoid arthritis patients with inadequate response to conventional DMARDs: a network meta-analysis. J Manag Care Spec Pharm. 2015;21(5):409–23.

    PubMed  Google Scholar 

  32. Singh JA, Hossain A, Tanjong Ghogomu E, Mudano AS, Maxwell LJ, Buchbinder R, et al. Biologics or tofacitinib for people with rheumatoid arthritis unsuccessfully treated with biologics: a systematic review and network meta-analysis. Cochrane Database Syst Rev. 2017;3:CD012591.

    PubMed  Google Scholar 

  33. Jin Y, Desai RJ, Liu J, Choi NK, Kim SC. Factors associated with initial or subsequent choice of biologic disease-modifying antirheumatic drugs for treatment of rheumatoid arthritis. Arthritis Res Ther. 2017;19(1):159.

    PubMed  PubMed Central  Google Scholar 

  34. Johnson KJ, Sanchez HN, Schoenbrunner N. Defining response to TNF-inhibitors in rheumatoid arthritis: the negative impact of anti-TNF cycling and the need for a personalized medicine approach to identify primary non-responders. Clin Rheumatol. 2019;38(11):2967–76.

    PubMed  Google Scholar 

  35. Nikas SN, Voulgari PV, Alamanos Y, Papadopoulos CG, Venetsanopoulou AI, Georgiadis AN, et al. Efficacy and safety of switching from infliximab to adalimumab: a comparative controlled study. Ann Rheum Dis. 2006;65(2):257–60.

    CAS  PubMed  Google Scholar 

  36. Smolen JS, Kay J, Doyle M, Landewé R, Matteson EL, Gaylis N, et al. Golimumab in patients with active rheumatoid arthritis after treatment with tumor necrosis factor α inhibitors: findings with up to five years of treatment in the multicenter, randomized, double-blind, placebo-controlled, phase 3 GO-AFTER study. Arthritis Res Ther. 2015;17:14.

    PubMed  PubMed Central  Google Scholar 

  37. Weinblatt ME, Fleischmann R, Huizinga TW, Emery P, Pope J, Massarotti EM, et al. Efficacy and safety of certolizumab pegol in a broad population of patients with active rheumatoid arthritis: results from the REALISTIC phase IIIb study. Rheumatology (Oxford). 2012;51(12):2204–14.

    CAS  Google Scholar 

  38. Smolen JS, Burmester GR, Combe B, Curtis JR, Hall S, Haraoui B, et al. Head-to-head comparison of certolizumab pegol versus adalimumab in rheumatoid arthritis: 2-year efficacy and safety results from the randomised EXXELERATE study. Lancet. 2016;388(10061):2763–74.

    CAS  PubMed  Google Scholar 

  39. Harrold LR, Reed GW, Magner R, Shewade A, John A, Greenberg JD, et al. Comparative effectiveness and safety of rituximab versus subsequent anti-tumor necrosis factor therapy in patients with rheumatoid arthritis with prior exposure to anti-tumor necrosis factor therapies in the United States Corrona registry. Arthritis Res Ther. 2015;17:256.

    PubMed  PubMed Central  Google Scholar 

  40. Emery P, Gottenberg JE, Rubbert-Roth A, Sarzi-Puttini P, Choquette D, Taboada VM, et al. Rituximab versus an alternative TNF inhibitor in patients with rheumatoid arthritis who failed to respond to a single previous TNF inhibitor: SWITCH-RA, a global, observational, comparative effectiveness study. Ann Rheum Dis. 2015;74(6):979–84.

    CAS  PubMed  Google Scholar 

  41. Frisell T, Dehlin M, Di Giuseppe D, Feltelius N, Turesson C, Askling J, et al. Comparative effectiveness of abatacept, rituximab, tocilizumab and TNFi biologics in RA: results from the nationwide Swedish register. In: Rheumatology (Oxford); 2019.

    Google Scholar 

  42. Gottenberg JE, Brocq O, Perdriger A, Lassoued S, Berthelot JM, Wendling D, et al. Non-TNF-targeted biologic vs a second anti-TNF drug to treat rheumatoid arthritis in patients with insufficient response to a first anti-TNF drug: a randomized clinical trial. JAMA. 2016;316(11):1172–80.

    CAS  PubMed  Google Scholar 

  43. Todoerti M, Favalli EG, Iannone F, Olivieri I, Benucci M, Cauli A, et al. Switch or swap strategy in rheumatoid arthritis patients failing TNF inhibitors? Results of a modified Italian Expert Consensus. Rheumatology (Oxford). 2018;57(57 Suppl 7):vii42–53.

    CAS  Google Scholar 

  44. Tanaka Y, Hirata S, Kubo S, Fukuyo S, Hanami K, Sawamukai N, et al. Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study. Ann Rheum Dis. 2015;74(2):389–95.

    CAS  PubMed  Google Scholar 

  45. Nishimoto N, Amano K, Hirabayashi Y, Horiuchi T, Ishii T, Iwahashi M, et al. Drug free REmission/low disease activity after cessation of tocilizumab (Actemra) Monotherapy (DREAM) study. Mod Rheumatol. 2014;24(1):17–25.

    CAS  PubMed  Google Scholar 

  46. Haschka J, Englbrecht M, Hueber AJ, Manger B, Kleyer A, Reiser M, et al. Relapse rates in patients with rheumatoid arthritis in stable remission tapering or stopping antirheumatic therapy: interim results from the prospective randomised controlled RETRO study. Ann Rheum Dis. 2016;75(1):45–51.

    PubMed  Google Scholar 

  47. Emery P, Hammoudeh M, FitzGerald O, Combe B, Martin-Mola E, Buch MH, et al. Sustained remission with etanercept tapering in early rheumatoid arthritis. N Engl J Med. 2014;371(19):1781–92.

    CAS  PubMed  Google Scholar 

  48. Fautrel B, Pham T, Alfaiate T, Gandjbakhch F, Foltz V, Morel J, et al. Step-down strategy of spacing TNF-blocker injections for established rheumatoid arthritis in remission: results of the multicentre non-inferiority randomised open-label controlled trial (STRASS: Spacing of TNF-blocker injections in Rheumatoid ArthritiS Study). Ann Rheum Dis. 2016;75(1):59–67.

    PubMed  Google Scholar 

  49. •• Henaux S, Ruyssen-Witrand A, Cantagrel A, Barnetche T, Fautrel B, Filippi N, et al. Risk of losing remission, low disease activity or radiographic progression in case of bDMARD discontinuation or tapering in rheumatoid arthritis: systematic analysis of the literature and meta-analysis. Ann Rheum Dis. 2018;77(4):515–22 A systematic analysis of the literature and meta-analysis that demonstrate that tapering of biologic DMARD does not increase the risk of radiographic progression, though there is a risk of losing remission.

    PubMed  Google Scholar 

  50. Rech J, Hueber AJ, Finzel S, Englbrecht M, Haschka J, Manger B, et al. Prediction of disease relapses by multibiomarker disease activity and autoantibody status in patients with rheumatoid arthritis on tapering DMARD treatment. Ann Rheum Dis. 2016;75(9):1637–44.

    CAS  PubMed  Google Scholar 

  51. Mäkinen H, Kautiainen H, Hannonen P, Sokka T. Is DAS28 an appropriate tool to assess remission in rheumatoid arthritis? Ann Rheum Dis. 2005;64(10):1410–3.

    PubMed  PubMed Central  Google Scholar 

  52. Aviña-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008;59(12):1690–7.

    PubMed  Google Scholar 

  53. D’Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743–53.

    PubMed  Google Scholar 

  54. •• Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017;76(1):17–28 Recommendations on management of cardiovascular disease in patients with RA.

    CAS  PubMed  Google Scholar 

  55. Arts EE, Fransen J, Den Broeder AA, van Riel PLCM, Popa CD. Low disease activity (DAS28≤3.2) reduces the risk of first cardiovascular event in rheumatoid arthritis: a time-dependent Cox regression analysis in a large cohort study. Ann Rheum Dis. 2017.

  56. Burggraaf B, van Breukelen-van der Stoep DF, de Vries MA, Klop B, Liem AH, van de Geijn GM, et al. Effect of a treat-to-target intervention of cardiovascular risk factors on subclinical and clinical atherosclerosis in rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis. 2019;78(3):335–41.

    CAS  PubMed  Google Scholar 

  57. Semb AG, Kvien TK, Aastveit AH, Jungner I, Pedersen TR, Walldius G, et al. Lipids, myocardial infarction and ischaemic stroke in patients with rheumatoid arthritis in the Apolipoprotein-related Mortality RISk (AMORIS) Study. Ann Rheum Dis. 2010;69(11):1996–2001.

    CAS  PubMed  Google Scholar 

  58. Myasoedova E, Crowson CS, Kremers HM, Roger VL, Fitz-Gibbon PD, Therneau TM, et al. Lipid paradox in rheumatoid arthritis: the impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease. Ann Rheum Dis. 2011;70(3):482–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  59. Giles JT, Wasko MCM, Chung CP, Szklo M, Blumenthal RS, Kao A, et al. Exploring the lipid paradox theory in rheumatoid arthritis: associations of low circulating low-density lipoprotein concentration with subclinical coronary atherosclerosis. Arthritis Rheum. 2019;71(9):1426–36.

    CAS  Google Scholar 

  60. Jagpal A, Navarro-Millán I. Cardiovascular co-morbidity in patients with rheumatoid arthritis: a narrative review of risk factors, cardiovascular risk assessment and treatment. BMC Rheumatol. 2018;2:10.

    PubMed  PubMed Central  Google Scholar 

  61. Giles JT, Sattar N, Gabriel S, Ridker PM, Gay S, Warne C, et al. Cardiovascular safety of tocilizumab versus etanercept in rheumatoid arthritis: a randomized controlled trial. Arthritis Rheum. 2020;72(1):31–40.

    CAS  Google Scholar 

  62. Singh S, Fumery M, Singh AG, Singh N, Prokop LJ, Dulai PS, et al. Comparative risk of cardiovascular events with biologic and synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: a systematic review and meta-analysis. Arthritis Care Res. 2020;72(4):561–76.

    CAS  Google Scholar 

  63. Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2935–59.

    PubMed  Google Scholar 

  64. Singh JA, Saag KG, Bridges SL Jr, Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology Guideline for the Treatment of rheumatoid arthritis. Arthritis Care Res. 2016;68(1):1–25.

    Google Scholar 

Download references

Acknowledgments

The views in this article are solely the responsibility of the author(s) and do not necessarily represent the views of the Department of Veterans Affairs.

Funding

No direct funding was obtained for preparing this article. Dr. Singh is supported by the resources and use of facilities at the Birmingham VA Medical Center, Birmingham, AL, USA.

Author information

Authors and Affiliations

  1. Division of Rheumatology, University of Alabama at Birmingham, 510 20th Street S Office # 836, Birmingham, AL, 35233, USA

    Aprajita Jagpal MD & Jasvinder A. Singh MBBS, MPH

  2. Birmingham VA Medical Center, Birmingham, AL, USA

    Jasvinder A. Singh MBBS, MPH

  3. Department of Epidemiology, UAB School of Public Health, 1665 University Blvd., Ryals Public Health Building, Room 220, Birmingham, AL, 35294-0022, USA

    Jasvinder A. Singh MBBS, MPH

Authors
  1. Aprajita Jagpal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jasvinder A. Singh MBBS, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aprajita Jagpal MD.

Ethics declarations

Conflict of Interest

Aprajita Jagpal (AJ) declares that she has no conflict of interest. Jasvinder A Singh (JAS) has received consultant fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Clinical Care options, Clearview healthcare partners, Putnam associates, Spherix, Practice Point communications, the National Institutes of Health, and the American College of Rheumatology. JAS owns stock options in Amarin pharmaceuticals and Viking therapeutics. JAS is on the speaker’s bureau of Simply Speaking. JAS is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 12 companies. JAS serves on the FDA Arthritis Advisory Committee. JAS is a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. JAS previously served as a member of the following committees: member, the American College of Rheumatology’s (ACR) Annual Meeting Planning Committee (AMPC) and Quality of Care Committees, the Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee, and the co-chair of the ACR Criteria and Response Criteria subcommittee.

Role of the Funder/Supporter

The funding bodies did not play any role in design, in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

IRB Approval

Since this was not a research study, no IRB approval was needed.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Rheumatoid Arthritis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jagpal, A., Singh, J.A. Treatment Guidelines in Rheumatoid Arthritis—Optimizing the Best of Both Worlds. Curr Treat Options in Rheum 6, 354–369 (2020). https://doi.org/10.1007/s40674-020-00163-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40674-020-00163-w

Keywords

Search

Navigation