Table 4.

Treatment modification^*

Recommendations	Certainty of evidence	Based on the evidence report(s) of the following PICO(s)	Evidence table(s), in Supp. App. 2
A TTT approach is strongly recommended over usual care for patients who have not been previously treated with bDMARDs or tsDMARDs.	Low	PICO 12.a	p. 191
A TTT approach is conditionally recommended over usual care for patients who have had an inadequate response to bDMARDs or tsDMARDs.	Very low	PICO 12.b	p. 199
A minimal initial treatment goal of low disease activity is conditionally recommended over a goal of remission.	Low	PICO 13	p. 201
Addition of a bDMARD or tsDMARD is conditionally recommended over triple therapy for patients taking maximally tolerated doses of methotrexate who are not at target.	Very low	PICO 19.C2–C6†	p. 240–1
Switching to a bDMARD or tsDMARD of a different class is conditionally recommended over switching to a bDMARD or tsDMARD belonging to the same class for patients taking a bDMARD or tsDMARD who are not at target.	Very low	PICO 24–27†	p. 293–338
Addition of/switching to DMARDs is conditionally recommended over continuation of glucocorticoids for patients taking glucocorticoids to remain at target.	Very low	PICO 23	p. 292
Addition of/switching to DMARDs (with or without IA glucocorticoids) is conditionally recommended over the use of IA glucocorticoids alone for patients taking DMARDs who are not at target.	Very low	PICO 28.C1–C2	p. 339–40

^*PICO = population, intervention, comparator, and outcomes; Supp. App. 2=Supplementary Appendix 2, available on the Arthritis Care & Research website at http://onlinelibrary.wiley.com/doi/10.1002/acr.24596/abstract; TTT = treat-to-target; bDMARDs = biologic disease-modifying antirheumatic drugs; tsDMARDs = targeted synthetic DMARDs; IA = intraarticular.

^†The original PICO included individual DMARDs as comparators. The recommendation considers bDMARDs as a group.