Recommendations of the Argentine Society of Rheumatology for the Treatment of Patients With Rheumatoid Arthritis: 2025 Update Part I

Background: Rheumatoid arthritis (RA) is a severe, systemic chronic rheumatic disease, and it is important for each country and/or region to develop management recommendations adapted to its needs and resources. Objectives: To update the Argentine treatment recommendations for the management of patients with RA. Methods: The working group comprised a principal investigator, 8 methodologists and 23 expert rheumatologists. Seventy-one PICO questions were developed. A systematic literature review (SLR) was conducted using the Medline (PubMed), LILACS, and Cochrane Library databases. Grey literature was also searched. The evidence was appraised using the GRADE methodology. Voting was anonymous and conducted virtually, and recommendations required at least 70% agreement to achieve consensus. Results: A total of 21 recommendations were developed, addressing Mediterranean diet, subcutaneous versus oral methotrexate, and therapeutic strategies across different clinical scenarios, including: csDMARD naive, inadequate response (IR) to csDMARD, IR to b/tsDMARD (cycling versus swapping), monotherapy, tapering in patients with sustained remission, and management of patients with concomitant interstitial lung disease or rheumatoid vasculitis. In most cases, the levels of evidence and degrees of agreement were moderate. Conclusions: These recommendations are intended to be a practical tool to assist rheumatologists in making the most appropriate treatment decisions for their patients.