6
Treatment
Table 4. Treatment Modification
Recommendations
Certainty of
Evidence
For patients who have not been previously treated with bDMARDs
or tsDMARDs, a TTT approach is strongly recommended over
usual care.
Low
For patients who have had an inadequate response to bDMARDs or
tsDMARDs, a TTT approach is conditionally recommended over
usual care.
Very low
A minimal initial treatment goal of low disease activity is
conditionally recommended over a goal of remission.
Low
For patients taking maximally tolerated doses of methotrexate
who are not at target, addition of a bDMARD or tsDMARD is
conditionally recommended over triple therapy.
Very low
For patients taking a bDMARD or tsDMARD who are not at
target, a switch to a bDMARD or tsDMARD of a different class
is conditionally recommended over a switch to a bDMARD or
tsDMARD belonging to the same class.
Very low
For patients taking glucocorticoids to remain at target, addition/
switch of DMARDs is conditionally recommended over
continuation of glucocorticoids.
Very low
For patients taking DMARDs who are not at target, addition/switch
of DMARDs (with or without intraarticular (IA) glucocorticoids) is
conditionally recommended over IA glucocorticoids alone.
Very low
