Canadian Rheumatology Association Living Guidelines for Rheumatoid Arthritis: Update #1

We have updated the Canadian Rheumatology Association (CRA) guidelines for rheumatoid arthritis, with a series of best practice statements and a recommendation for the choice of disease-modifying antirheumatic drug therapy after an inadequate response to tumor necrosis factor inhibitors (TNFi).These add to our prior recommendation for tapering of advanced therapy. 1 The full list of best practice statements and treatment recommendations is summarized (Table ).Readers should always consult the online version of the guideline, 2 which will always be the latest version with all recommendations, and include important contextual information for each recommendation, along with supporting evidence summaries.The online version is available via an interactive web-based platform for guideline authoring and publication (MAGICapp) and can be accessed directly (https://app.magicapp.org/#/guideline/jNxw7n)or through the CRA website (www.rheum.ca).The recommendations and statements were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. 3Consistent with CRA processes, a full evidence-to-decision framework that summarizes the evidence and rationale for the recommendation is available for each treatment recommendation in the online version of the guideline.For the best practice statements, we present an explicit rationale for each statement following GRADE guidance, 4 also available in the online version of the guideline.We will continue to develop recommendations over time, and these will be added to the online version of the guideline on MAGICapp as they are developed.