Rethinking the discordance between guidelines and practice in rheumatoid arthritis treatment A failure of practice, or a failure of evidence?

Abstract

drug treatment of rheumatoid arthritis (RA) has evolved significantly in recent decades, owing to increasing evidence supporting early intervention with disease-modifying therapies and the advent of novel biological therapies that specifically target the immunological and cellular mediators of disease. In the past 10 years, there have been over 60 systematic reviews and meta-analyses of pharmacotherapy in RA, reflecting the growth in development of new drugs and the shifting landscape of treatment regimens. Although these reviews vary in scope and focus, there is considerable overlap of the studies that are included. The findings of these reviews are mostly consistent and support early use of disease-modifying antirheumatic drugs (DMARDs) titrated appropriately for control of the disease process; the safety and efficacy of methotrexate as a first-line agent; and the clinical utility of corticosteroids in managing disease flares