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Patient-derived functional measures such as the Health Assessment Questionnaire (HAQ) are important tools in the assessment of general health, function, and disability in patients with rheumatic diseases, such as rheumatoid arthritis. In this Viewpoint, Dr Aletaha and Dr Smolen discuss the use of these measures and their derivatives in predicting outcome in patients with rheumatic disease.

Systematic reviews, although they can highlight important findings in the literature, often raise even more questions. In this Viewpoint, Prof Smolen and Prof Aletaha discuss approaches to comprehensive reviews in general, and to those involving rheumatoid arthritis in particular, from the clinical trialist's point of view.

Tapering or even discontinuation of drug therapy for rheumatoid arthritis is a desirable goal, given patient preferences in addition to safety and financial concerns, but the implications of this approach are far from clear. A multicenter study conducted in Japan has explored whether stopping treatment with a tumor necrosis factor inhibitor is a viable option once a state of low disease activity has been attained.

Despite the availability of numerous treatment options, the management of rheumatoid arthritis remains suboptimal. In this Review, Konzett and Aletaha discuss strategies to advance clinical decision-making from trial-and-error to an informed process that considers more than just drug efficacy, and appropriately balances effort and success.

Choosing the correct management strategy for patients with rheumatoid arthritis in order to achieve the best possible outcome is a challenge to all rheumatologists. This Viewpoint considers current progress in the field of outcomes research in rheumatoid arthritis, along with future prospects of predicting individual patient response to therapy.

For too long, the definition of ‘remission’ in rheumatoid arthritis has been distorted by the widespread use of an inadequate tool, with consequences for clinical care and for making sense of clinical trial data. Has the time come to move away from DAS28-defined remission?

Optimizing COVID-19 vaccination strategies for patients under immunosuppressive medication is of high importance. In this clinical trial including non-seroconverted immunosuppressed patients, a homologous mRNA booster vaccination resulted in higher seroconversion rate than a switch to a vector-based vaccine.

Targeted therapies and novel strategies to optimize their use enable many patients with RA to achieve a state of low disease activity or even remission, which can be maintained even after tapering or withdrawal of biologic DMARDs. In this article, Smolen and Aletaha review current concepts of RA treatment and the clinical evidence for their effectiveness, in the context of relevant issues such as factors influencing response to therapy, the 'window of opportunity' hypothesis and definitions of treatment targets.

Undifferentiated arthritis (UA) was redefined by the introduction of the 2010 rheumatoid arthritis (RA) classification criteria. But UA is more than just not having RA — it is about selecting the right patients for DMARD treatment even before diagnosis, and about protecting those with self-limiting disease from potential drug toxicity.

The authors identify feeblin, an inhibitory compound of the proinflammatory TLR7/8/9-IRF5 pathway with therapeutic potential, which acts by binding SLC15A4 via an allosteric mechanism mediating degradation of its signaling partner TASL.

A meta-analysis comparing primary efficacy outcomes of phase 2 and phase 3 randomized controlled trials in rheumatoid arthritis and psoriatic arthritis shows that phase 2 studies consistently overestimate the effect sizes anticipated in subsequent phase 3 trials.

Despite their different targets, biologic agents used for blockade of TNF and IL 6, inhibition of T cell co-stimulation and B cell depletion all have similar beneficial effects on the outcome of rheumatoid arthritis (RA). This observation raises questions as to whether the targets of these therapies might all be involved in a common pathogenetic pathway. In this Perspective, the authors discuss the disparities in RA therapy and whether clinical trial data can be used to determine at which point a biologic agent might interfere with the pathogenetic RA cascade.

Early diagnosis of immune-mediated arthropathies is important for early and effective treatment, but often relies on clinical expertise. Can the use of a new genetic risk score help rule out and prioritize certain diagnoses? And does this score add any clinical utility to current clinical diagnostic pathways?

Rheumatoid arthritis is a chronic, inflammatory, autoimmune disease that primarily affects the joints. This Primer by Smolen et al. provides the latest insights into the epidemiology, genetics, pathophysiology, diagnostic approaches, clinical assessment and management of rheumatoid arthritis.