The European Alliance of Associations for Rheumatology (EULAR) released updated recommendations for the management of rheumatoid arthritis in March 2026, according to a publication on the Annals of the Rheumatic Diseases website. The new guidance is based on recent evidence and strategic developments in disease-modifying antirheumatic drugs (DMARDs), although no new drugs have been approved since the last update in 2022.
These recommendations are important because they help healthcare professionals worldwide make informed decisions about treating rheumatoid arthritis, which is the most common inflammatory rheumatic disease. The fifth update reduces the number of individual recommendations from eleven to nine, making it the smallest set since EULAR began issuing this guidance fifteen years ago. This change aims to simplify clinical approaches and includes a graphic algorithm to condense key insights.
The updated document outlines five overarching principles and nine specific recommendations. It emphasizes that rheumatologists should primarily care for people with rheumatoid arthritis and that treatment decisions should be made jointly by patients and clinicians, considering disease activity, safety, comorbidities, and progression of structural damage. The guidance also notes that multiple therapies may be needed over a patient's lifetime due to varying drug mechanisms and responses.
Josef Smolen, convenor of the task force, Editor-in-Chief of ARD, and Professor emeritus at the Medical University of Vienna in Austria, said: "In the last 15 years EULAR has provided the support to assemble one of the largest task forces in the field with experts from across the globe, allowing the development of recommendations for the management of RA that include important and highly valuably international input." He added: "Informed by thorough assessment of the most recent research activities, the new recommendations continue to be at the forefront of guidance for clinical practice and approaches to future scientific developments."
A notable change is that after discontinuing glucocorticoids and achieving sustained remission, there is now a preference for continuing DMARD therapy rather than reducing or stopping it altogether. Christopher Edwards, co-convenor of the task force, EULAR board member and Professor at the University of Southampton in United Kingdom said: "A cure for RA is still rare, and for most patients stopping treatment altogether leads to the disease flaring, especially for patients on biologic or JAK inhibitor therapies." He continued: "While carefully reducing medication can be successful for some people, completely stopping treatment is generally not advised. The updated recommendations continue to highlight that treatment decisions should be made jointly by patients and clinicians, ensuring that care is tailored to each individual's needs and preferences."
EULAR hopes these streamlined guidelines will better support therapeutic decisions for people living with rheumatoid arthritis.
