Table 3.

Treatment recommendations with poor prognostic factors as decision-criteria

	RA state	Poor prognostic factors	Presence allows for	Treatment target
EULAR [3]	RA, first DMARD failure	High disease activity, RF/ACPA positivity, early presence of joint damage	bDMARDs	Low disease activity or remission
ACR [4]	Early RA <6 months	Moderate disease activity + ≥1 of functional limitation, extraarticular disease, RF/ACPA positivity, erosions	csDMARD combination
		High disease activity + one or more of functional limitation, extra-articular disease, RF/ACPA positivity, erosions	bDMARD or csDMARD combination
	Established RA (≥6 months or 1987 ACR criteria)	LDA + one or more of functional limitation, extraarticular disease, RF/ACPA positivity, erosions or at least moderate disease activity	csDMARD combination, bDMARD at 3 months
Italy [5]	RA, DMARD failure	1. High disease activity (DAS28 > 5.1 for ≥1 months 2. Moderate disease activity (DAS >3.2) + ACPA/RF positive and elevated CRP or ESR, persistence of one or more swollen joint, bone erosions on X-rays, active synovitis with power Doppler signal 3. New erosions	bDMARD
France [35]	RA, DMARD failure	Existence or progression of structural damage, high clinical and/or laboratory activity, high RF/ACPA titers	bDMARD
Germany [34]	RA, 1st DMARD failure	High disease activity, RF/ACPA positivity, early presence of joint damage	bDMARD
Canada [36]	RA	Not further specified	Initial csDMARD combination

ACPA anti-citrullinated protein-peptide antibodies, ACR American College of Rheumatology, CRP C-reactive protein, ESR erythrocyte sedimentation rate, EULAR European League Against Rheumatism, DAS disease activity score, bDMARD biologic disease-modifying antirheumatic drug, csDMARD conventional synthetic disease-modifying antirheumatic drug, RA rheumatoid arthritis, RF rheumatoid factor