Rheumatology content commonly referenced by physicians includes major treatment guidelines, disease-modifying therapies, pivotal efficacy and safety trials, and standardized tools for assessing disease activity and fracture risk. The following 10-item framework reflects widely used sources that inform rheumatology care.

1. European Alliance of Associations for Rheumatology Rheumatoid Arthritis Management Recommendations — Updated European Alliance of Associations for Rheumatology recommendations for rheumatoid arthritis management address conventional synthetic, biologic, and targeted synthetic disease-modifying antirheumatic drugs, glucocorticoids, treat-to-target strategies, treatment sequencing, and tapering. The recommendations call for initial methotrexate, ideally with short-term glucocorticoids, followed by addition of a biologic disease-modifying antirheumatic drug if response is insufficient after 3 to 6 months. Janus kinase inhibitors may also be considered after assessment of risks of major cardiovascular events, malignancies, and thromboembolic events, and disease-modifying therapy may be tapered in patients with sustained remission, although stopping treatment often leads to disease flare.

2. American College of Rheumatology Systemic Lupus Erythematosus Guideline — The American College of Rheumatology guideline for systemic lupus erythematosus provides recommendations for treatment and management in pediatric and adult patients. The recommendations highlight hydroxychloroquine treatment, limiting the duration of glucocorticoid use, and early introduction of conventional or biologic immunosuppressive therapies to achieve and maintain remission or low disease activity while reducing morbidity and mortality associated with systemic lupus erythematosus and minimizing treatment-related toxicities. The guideline also supports shared decision-making based on each patient’s clinical circumstances and preferences.

3. American College of Rheumatology Lupus Nephritis Guideline — The American College of Rheumatology guideline for lupus nephritis provides recommendations for screening, treatment, and management. The recommendations describe therapy as a continuous approach rather than separate initial and maintenance phases. For patients who achieve a complete renal response, the recommended approach includes pulse glucocorticoids followed by an oral glucocorticoid taper and 2 additional immunosuppressive agents, with a total duration of immunosuppressive therapy of at least 3 to 5 years. The guideline also notes that treatment decisions may vary according to each patient’s clinical circumstances and preferences.

4. American College of Rheumatology Gout Guideline — The American College of Rheumatology guideline for gout addresses urate-lowering therapy, treatment of gout flares, and lifestyle and medication recommendations. The guideline recommends urate-lowering therapy for patients with tophaceous gout, gout-related radiographic damage, or frequent flares, with allopurinol as the preferred first-line option, including in patients with moderate to severe chronic kidney disease. A treat-to-target strategy is recommended, with urate-lowering therapy dose titration guided by serial serum urate measurements and a target below 6 mg/dL. Colchicine, nonsteroidal anti-inflammatory drugs, or glucocorticoids are recommended for management of gout flares. The guideline also recommends anti-inflammatory prophylaxis for at least 3 to 6 months when urate-lowering therapy is initiated.

5. ORAL Surveillance Trial — In the randomized ORAL Surveillance trial involving patients with active rheumatoid arthritis despite methotrexate treatment who were aged 50 years or older and had at least 1 additional cardiovascular risk factor, major adverse cardiovascular events occurred in 3.4% (98 patients) across the combined tofacitinib groups compared with 2.5% (37 patients) receiving a tumor necrosis factor inhibitor. Cancers excluding nonmelanoma skin cancer occurred in 4.2% (122 patients) vs 2.9% (42 patients), respectively. Tofacitinib did not meet noninferiority criteria compared with tumor necrosis factor inhibitor therapy for these outcomes.

6. SAPHYR Trial — In the phase 3 SAPHYR trial involving patients with relapsing polymyalgia rheumatica during glucocorticoid tapering, sustained remission at 52 weeks occurred in 28% (17 of 60) of patients receiving sarilumab with a 14-week prednisone taper compared with 10% (6 of 58) of patients receiving placebo with a 52-week prednisone taper. The median cumulative glucocorticoid dose at 52 weeks was 777 mg with sarilumab vs 2,044 mg with placebo. Neutropenia (15% vs 0%), arthralgia (15% vs 5%), and diarrhea (12% vs 2%) were more common with sarilumab.

7. Bimekizumab — US Food and Drug Administration (FDA) labeling states that bimekizumab is an interleukin-17A and interleukin-17F antagonist indicated for adults with active psoriatic arthritis, active nonradiographic axial spondyloarthritis with objective signs of inflammation, and active ankylosing spondylitis. The drug was evaluated in randomized, double-blind, placebo-controlled studies across these indications.

8. Upadacitinib for Giant Cell Arteritis — FDA labeling states that upadacitinib is indicated for adults with giant cell arteritis. In a 52-week clinical trial, 428 patients were randomized to receive upadacitinib 15 mg, upadacitinib 7.5 mg, or placebo. Corticosteroids were administered as background therapy in all treatment groups.

9. Rheumatoid Arthritis Disease Activity Measures — Updated American College of Rheumatology recommendations identify 5 preferred measures for regular use in assessing rheumatoid arthritis disease activity: the Disease Activity Score in 28 Joints with Erythrocyte Sedimentation Rate or C-Reactive Protein Level, Clinical Disease Activity Index, Simplified Disease Activity Index, Routine Assessment of Patient Index Data 3, and Patient Activity Scale-II. The measures were selected from 11 that met minimum standards for regular use in most clinical settings and are intended to facilitate a treat-to-target approach in routine care.

10. FRAX Fracture Risk Assessment Tool — The FRAX tool estimates fracture risk using clinical risk factors and femoral neck bone mineral density. It provides the 10-year probability of hip fracture and major osteoporotic fracture, including clinical spine, forearm, hip, or shoulder fracture. The tool is available electronically, with simplified paper versions available for office use.

Sources: European Alliance of Associations for Rheumatology, American College of Rheumatology, The New England Journal of Medicine, US Food and Drug Administration, Annals of the Rheumatic Diseases, Arthritis Care & Research, FRAX