2
Key Points
` The updated 2021 ACR treatment recommendations for patients with
rheumatoid arthritis (RA) emphasize:
• Initiating methotrexate early for the treatment of patients with moderate to high
disease activity.
• Adjusting methotrexate to achieve maximal benefit prior to adding additional disease
modifying anti-rheumatic drugs.
• Minimizing the use of glucocorticoids whenever possible.
• Implementing a treat to target (TTT) strateg y.
Certainty of Evidence and Strength of Recommendations
Certainty of
Evidence Interpretation
High-certainty of
evidence
Evidence that provides high confidence in the effect estimate.
New data are unlikely to change the recommendation.
Moderate-
certainty of
evidence
Evidence that provides confidence that the true effect is likely to
be close to the estimate but could be substantially different.
Low-certainty of
evidence
Evidence that provides limited confidence about the effect. e
true effect may be substantially different from the estimate.
Very low-certainty
of evidence
Evidence that provide very little certainty about the effect. e
true effect may be quite different from the estimate.
Strength of
Recommendation Interpretation
Strong
recommendation
Reflect scenarios supported by moderate or high certainty of
evidence where the benefits consistently outweigh the risks, and,
with only rare exceptions, an informed patient and their provider
would be expected to reach the same decision. Should not be
taken to imply that the intervention has large clinical benefits.
Conditional
recommendation
Reflect scenarios for which the benefits and risks may be more
closely balanced and/or only low certainty of evidence or no data
are available.
