Recommendations of the Argentine Society of Rheumatology for the Treatment of Patients With Rheumatoid Arthritis. Update 2025 Part II. Definitions in the Context of RA Treatment and Therapeutic Strategies for Special Situations and Comorbidities.

Abstract

Background: In the context of treatment recommendations for rheumatoid arthritis (RA), it is important to establish definitions related to treatment adjusted in specific situations and in the presence of comorbidities.

Objectives: To develop recommendations based on the best evidence regarding to the treatment of patients with RA in special situations, healthy habits, and the presence of comorbidities.

Methods: A systematic literature review was conducted in PubMed, LILACS, and the Cochrane Library until April 30, 2023. Two independent methodologists selected studies. Draft statements were developed and voted on, with ≥70% agreement required for inclusion.

Results: Fifty-four statements were formulated. Key recommendations include: against treatment in asymptomatic high-risk individuals without clinical arthritis (preclinical RA); the use of methotrexate in seropositive patients with imaging-detected subclinical arthritis; definitions for early RA, window of opportunity, difficult-to-treat RA, and sustained remission; guidance on DMARD during pregnancy and breastfeeding; preference for non-TNF biologics in obese patients; caution with TNFi in stage III to IV congestive heart failure; antiviral prophylaxis in chronic hepatitis B; and structured recommendations on oral hygiene and smoking cessation.

Conclusions: These statements complement general RA treatment recommendations and support better patient management, based on scientific evidence and adapted to the characteristics, resources, and opportunities of our country.