ACR and EULAR rheumatologic guidelines.

10 topics · 11 versions · 2 high-yield

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ANCA-associated vasculitis

anca-vasculitis · society: ACR/VF

First ACR/Vasculitis Foundation guideline for management of ANCA-associated vasculitis (GPA, MPA, EGPA), providing 26 recommendations + 5 position statements for GPA/MPA and 15 recommendations + 5 position statements for EGPA. Key themes: rituximab preferred over cyclophosphamide for remission induction and maintenance in severe GPA/MPA, mepolizumab introduced for non-severe EGPA, reduced-dose glucocorticoid regimens favored, and routine plasma exchange not recommended. All recommendations are conditional due to limited high-quality evidence. Avacopan was not considered (post-search FDA approval).

Axial spondyloarthritis

axial-spondyloarthritis · society: ACR/SAA/SPARTAN

2019 ACR/SAA/SPARTAN update of the 2015 recommendations for treatment of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA), focused on positioning of newer agents (secukinumab, ixekizumab, tofacitinib, TNFi biosimilars) and the role of imaging. NSAIDs and TNFi remain first-line pharmacologic therapy; IL-17 inhibitors are preferred over a second TNFi in primary TNFi non-responders, while a second TNFi is preferred for secondary non-response. New recommendations address against treat-to-target with ASDAS, against routine biologic tapering/discontinuation in stable disease, against mandated switching to a biosimilar, and against scheduled serial spine radiographs.

Glucocorticoid-induced osteoporosis

glucocorticoid-induced-osteoporosis · society: ACR

ACR 2017 update on prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) in adults and children on prednisone ≥2.5 mg/day for ≥3 months. Uses GRADE methodology and FRAX-based (GC-adjusted) fracture risk stratification to guide therapy, with oral bisphosphonates as preferred first-line agents in most moderate-to-high risk patients. Addresses special populations including children, organ transplant recipients, women of childbearing potential, and patients on very high-dose GCs.

Gout ⭐

gout · society: ACR · high-yield

The 2020 ACR Gout Management Guideline updates the 2012 version using GRADE methodology, providing 42 recommendations (16 strong) covering indications for urate-lowering therapy (ULT), ULT selection and titration, flare management, lifestyle, and concurrent medications. Key updates include allopurinol as preferred first-line ULT for all patients (including CKD stage ≥3), a strong endorsement of treat-to-target with serum urate <6 mg/dl, mandatory low-dose ULT initiation with concomitant anti-inflammatory prophylaxis for 3–6 months, and expanded ULT indications to include radiographic gout damage. Cost considerations and CVD safety signals with febuxostat now firmly position allopurinol over febuxostat as first-line.

Giant cell arteritis / Takayasu

large-vessel-vasculitis · society: ACR/VF

ACR/Vasculitis Foundation 2021 guideline on management of giant cell arteritis (GCA) and Takayasu arteritis (TAK), the two principal large-vessel vasculitides. Provides 22 recommendations plus 2 position statements for GCA and 20 recommendations plus 1 position statement for TAK, addressing diagnostic imaging/biopsy, induction and maintenance therapy, monitoring, and surgical management. Notable shifts include endorsement of tocilizumab as a glucocorticoid-sparing agent in GCA and continued preference for temporal artery biopsy (over ultrasound/MRI) in the US, diverging from EULAR. Nearly all recommendations are conditional given low-quality evidence.

Osteoarthritis

osteoarthritis · society: ACR/Arthritis Foundation

2019 ACR/Arthritis Foundation guideline updating the 2012 recommendations for management of hand, hip, and knee osteoarthritis using GRADE methodology. Emphasizes multimodal, shared decision-making care with exercise, weight loss, and self-management as foundational, plus topical/oral NSAIDs and intraarticular glucocorticoids as primary pharmacologic options. Notable changes from 2012 include a stronger recommendation against glucosamine, recommendations against hyaluronic acid injections (conditional for knee/CMC, strong for hip), and against TENS, stem cell, and PRP injections.

Polymyalgia rheumatica

polymyalgia-rheumatica · society: ACR/EULAR

First joint EULAR/ACR recommendations for management of polymyalgia rheumatica, developed using GRADE methodology. Provides 8 overarching principles and 9 specific recommendations covering baseline workup, glucocorticoid dosing and tapering, IM methylprednisolone alternative, early methotrexate use, exclusion of TNF inhibitors, and exercise. Emphasizes individualized minimum-effective GC dosing and shared decision-making rather than fixed schedules.

Psoriatic arthritis

psoriatic-arthritis · society: ACR/NPF

First joint ACR/NPF guideline for treating active psoriatic arthritis (PsA), using GRADE methodology to address pharmacologic and nonpharmacologic management in treatment-naive patients, those failing prior therapy, and special populations (axial disease, enthesitis, IBD, diabetes, recurrent infections). Notably recommends TNF inhibitor biologics as first-line over oral small molecules (OSMs) in most treatment-naive patients with active PsA—a departure from EULAR/GRAPPA which preferred OSMs first. Endorses a treat-to-target strategy, smoking cessation, and vaccination considerations around biologic initiation. 94% of recommendations are conditional based on low/very-low-quality evidence.

Rheumatoid arthritis ⭐

rheumatoid-arthritis · society: ACR · high-yield

The 2021 ACR guideline updates pharmacologic management of rheumatoid arthritis, covering csDMARDs, bDMARDs, tsDMARDs, glucocorticoids, and DMARD use in high-risk populations (liver disease, heart failure, lymphoproliferative disorder, prior serious infection, NTM lung disease). It includes 44 recommendations (7 strong, 37 conditional). Key changes from 2015 include initial hydroxychloroquine/sulfasalazine for low disease activity, removal of early-vs-established RA subgroups, and a strong push to minimize glucocorticoid exposure.

SLE / lupus nephritis

sle

KDIGO 2024 is a focused update of the lupus nephritis chapter from the 2021 Glomerular Diseases Guideline. The update incorporates the FDA/EMA approvals of belimumab and voclosporin as add-on immunosuppressive agents for LN. Recommendations follow GRADE methodology and are supplemented by expert practice points covering diagnosis, induction, maintenance, and special populations.

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