Suboptimal management of rheumatoid arthritis in the Middle East and Africa: could the EULAR recommendations be the start of a solution?

IntroductionRheumatoid arthritis (RA) is associated with joint destruc-tion, functional disability and an increased risk of comor-bidities and extra-articular manifestations, as well asincreased mortality and reduced workforce participation[1–8]. In recent years, knowledge about the underlyingpathogenesis and process of disease in RA has increased;this, coupled with significant advances in disease-modifyinganti-rheumatic drugs (DMARDs) has brought aboutunprecedented opportunities for the management of thecondition [9, 10]. In order to guide rheumatologists in theuse of new therapies and management strategies, the Euro-pean League Against Rheumatism (EULAR) developedevidence-based recommendations for the management ofRA on the principle that treatment of RA should aim for atarget of remission or low disease activity as soon as possi-ble in every patient [10]. In addition, recognising the im-portance of early identification of inflammatory synovitis inpatients who may be at high risk of persistent and/or erosive