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Joint Bone Spine. 2014 Jul;81(4):287-97. doi: 10.1016/j.jbspin.2014.05.002. Epub 2014 Jun 27.

Recommendations of the French Society for Rheumatology for managing rheumatoid arthritis.

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Department of Rheumatology, Nîmes University Hospital, EA 2415, Montpellier I University, 30029 Nîmes, France. Electronic address:
Sorbonne Universities, UPMC Univ Paris 06, GRC 08, institut Pierre Louis d'épidémiologie et de santé publique; AP-HP, Department of Rheumatology, CHU Pitié-Salpetrière, 75013 Paris, France.
Department of Rheumatology, Purpan Hospital, CHRU de Toulouse, Paul Sabatier Toulouse III University, UMR Inserm 1043-CNRS 5282, 31059 Toulouse, France.
Paris Descartes University - Department of Rheumatology -Cochin Hospital, Assistance Publique - Hôpitaux de Paris - INSERM (U1153): épidémiologie clinique et biostatistiques, PRES Sorbonne Paris-Cité, 75014 Paris, France.
Department of Rheumatology, Paris-Sud Universities Hospital, AP-HP, Inserm U 1012, Paris Sud University, 92276 Le Kremlin Bicêtre, France.
Cabinet de rhumatologie, 78200 Mantes la Jolie, Yvelines, France.
Department of rheumatology, CHU de la Cavale Blanche, boulevard Tanguy-Prigent, 29609 Brest, France; EA 2216, Bretagne Occidentale University, 29200 Brest, France.
Association nationale de défense contre l'arthrite rhumatoïde (ANDAR), 75014 Paris, France.
Department of rheumatology, Lapeyronie Hospital, CHRU de Montpellier, Montpellier I University, UMR 5535, 34295 Montpellier, France.



This article reports the latest recommendations of the French Society for Rheumatology (SFR) regarding the management of rheumatoid arthritis (RA).


New recommendations were developed by hospital- and community-based rheumatologists having extensive experience with RA and a patient self-help organization representative. They rest on the recently issued EULAR recommendations and a literature review.


Points emphasized in the 15 recommendations include the need to share treatment decisions between the rheumatologist and the patient, the acquisition by patients of self-management skills, remission or minimal disease activity as the treatment target, the need for initiating disease-modifying drugs as early as possible, and the usefulness of regular disease activity assessments to allow rapid treatment adjustments if needed (i.e., tight disease control). First-line methotrexate monotherapy is recommended, with concomitant short-term glucocorticoid therapy if indicated by the risk/benefit ratio. Patients who fail this approach (no response after 3 months or target not achieved after 6 months) can be considered for another synthetic disease-modifying antirheumatic drug (DMARD: leflunomide or sulfasalazine), combined synthetic DMARD therapy, or methotrexate plus a biologic, depending on the prognostic factors and patient characteristics. If the first biologic fails, switching to a second biologic is recommended. In the event of a sustained remission, cautious dosage reduction of the biological and/after synthetic DMARDs is in order.


These recommendations are designed to improve the management of patients with RA.


Biologics; Glucocorticoid therapy; Recommendations; Rheumatoid arthritis; Treatment

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