Table 6.

Specific patient populations^*

Recommendations	Certainty of evidence	Based on the evidence report(s) of the following PICO(s)	Evidence table(s), in Supp. App. 2
Subcutaneous nodules
Methotrexate is conditionally recommended over alternative DMARDs for patients with subcutaneous nodules who have moderate-to-high disease activity.	Very low	PICO 64	p. 427
Switching to a non-methotrexate DMARD is conditionally recommended over continuation of methotrexate for patients taking methotrexate with progressive subcutaneous nodules.	Very low	PICO 65	p. 428
Pulmonary disease
Methotrexate is conditionally recommended over alternative DMARDs for the treatment of inflammatory arthritis for patients with clinically diagnosed mild and stable airway or parenchymal lung disease who have moderate-to-high disease activity.	Very low	PICO 67	p. 430
Heart failure
Addition of a non–TNF inhibitor bDMARD or tsDMARD is conditionally recommended over addition of a TNF inhibitor for patients with NYHA class III or IV heart failure and an inadequate response to csDMARDs.	Very low	PICO 70	p. 435
Switching to a non–TNF inhibitor bDMARD or tsDMARD is conditionally recommended over continuation of a TNF inhibitor for patients taking a TNF inhibitor who develop heart failure.	Very low	PICO 71	p. 436
Lymphoproliferative disorder
Rituximab is conditionally recommended over other DMARDs for patients who have a previous lymphoproliferative disorder for which rituximab is an approved treatment and who have moderate-to-high disease activity.	Very low	PICO 75 and PICO 76	p. 446–7
Hepatitis B infection
Prophylactic antiviral therapy is strongly recommended over frequent monitoring alone for patients initiating rituximab who are hepatitis B core antibody positive (regardless of hepatitis B surface antigen status).	Very low	PICO 82	p. 459
Prophylactic antiviral therapy is strongly recommended over frequent monitoring alone for patients initiating any bDMARD or tsDMARD who are hepatitis B core antibody positive and hepatitis B surface antigen positive.	Very low	PICO 83	p. 464
Frequent monitoring alone is conditionally recommended over prophylactic antiviral therapy for patients initiating a bDMARD other than rituximab or a tsDMARD who are hepatitis B core antibody positive and hepatitis B surface antigen negative.	Very low	PICO 84	p. 471
Nonalcoholic fatty liver disease
Methotrexate is conditionally recommended over alternative DMARDs for DMARD-naive patients with nonalcoholic fatty liver disease, normal liver enzymes and liver function tests, and no evidence of advanced liver fibrosis who have moderate-to high disease activity.	Very low	PICO 87	p. 489
Persistent hypogammaglobulinemia without infection
In the setting of persistent hypogammaglobulinemia without infection, continuation of rituximab therapy for patients at target is conditionally recommended over switching to a different bDMARD or tsDMARD.	Very low	PICO 66	p. 429
Previous serious infection
Addition of csDMARDs is conditionally recommended over addition of a bDMARD or tsDMARD for patients with a serious infection within the previous 12 months who have moderate-to-high disease activity despite csDMARD monotherapy.	Very low	PICO 88	p. 490
Addition of/switching to DMARDs is conditionally recommended over initiation/dose escalation of glucocorticoids for patients with a serious infection within the previous 12 months who have moderate-to-high disease activity.	Very low	PICO 90 and PICO 91	p. 496–7
Nontuberculous mycobacterial lung disease
Use of the lowest possible dose of glucocorticoids (discontinuation if possible) is conditionally recommended over continuation of glucocorticoids for patients with nontuberculous mycobacterial lung disease.	Very low	No relevant PICO
Addition of csDMARDs is conditionally recommended over addition of a bDMARD or tsDMARD for patients with nontuberculous mycobacterial lung disease who have moderate-to-high disease activity despite csDMARD monotherapy.	Very low	PICO 92	p. 498
Abatacept is conditionally recommended over other bDMARDs and tsDMARDs for patients with nontuberculous mycobacterial lung disease who have moderate-to-high disease activity despite csDMARDs.	Very low	PICO 93	p. 499

^*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; DMARDs = disease-modifying antirheumatic drugs; TNF = tumor necrosis factor; bDMARD = biologic DMARD; tsDMARD = targeted synthetic DMARD; NYHA = New York Heart Association; csDMARDs = conventional synthetic DMARDs.