The goal of treatment for rheumatoid arthritis (RA) is to achieve sustained disease remission or low disease activity, and treatment should be initiated as soon as RA is diagnosed. The choice of treatment plan should be based on disease activity and the presence of adverse prognostic factors and co-morbidities. Poor prognostic factors include positive rheumatoid factor (RF) or anti-citrullinated protein antibodies, elevated blood sedimentation or C-reactive protein (CRP), and imaging evidence of joint erosion or progressive joint destruction (2B). All patients should be evaluated at follow-up for extra-articular manifestations of disease, co-morbidities, infections (e.g., tuberculosis and hepatitis), information on vaccination status and special conditions (e.g., pregnancy, breastfeeding). Screen for osteoporosis and cardiovascular disease. (2B) Glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs) may be reduced to discontinued if remission persists for 6 months. If remission is maintained for 6 to 12 months after discontinuation of NSAIDs, glucocorticoids, and biologic disease-modifying antirheumatic drugs (bDMARDs), the physician, in consultation with the patient, may cautiously taper synthetic DMARDs (cDMARDs) (4D). Regarding NSAIDs NSAIDs do not have a disease-modifying effect and slow the progression of RA (1A); non-selective NSAIDs and cyclooxygenase-2 (COX-2) inhibitors should be used at the lowest effective dose and for the shortest time allowed by the disease (4D); non-selective NSAIDs and COX-2 inhibitors should be evaluated for gastrointestinal, cardiovascular (1A) and renal function (2B) before treatment. Glucocorticoids Oral glucocorticoid monotherapy is not recommended for RA (4D); to control active RA, oral glucocorticoids can be used in combination with cDMARD (1A); in early RA, the addition of low-dose glucocorticoids (prednisolone ≤7.5 mg/d) can delay imaging progression (1A); glucocorticoids should be used at the lowest dose and tapered as soon as the disease allows ( 4D). Synthetic disease-modifying antirheumatic drugs (cDMARD) cDMARD monotherapy or combination therapy should be started as soon as RA is diagnosed (1A). Methotrexate (MTX) is the preferred cDMARD for RA and is considered the “anchor drug” (1A); for those who cannot tolerate MTX, other cDMARD treatments are available, such as leflunomide, salazosulfapyridine, and hydroxychloroquine as first-line options (1A), and in some Asia-Pacific countries, buspiramine, Elamod, cyclosporine, azathioprine, injectable gold preparations, or tacrolimus (1B). Complete blood cytometric analysis, liver and renal function, viral hepatitis serology and chest radiograph should be performed before MTX treatment (2B). Active RA, especially with poor prognostic factors, should be treated with a combination of cDMARD (1B); if MTX is not contraindicated, MTX should be used as an anchor drug for combination therapy (1A); triple therapy with cDMARD will be an effective option for patients who do not achieve complete remission with MTX monotherapy (1B). The disease should be evaluated every 1 to 3 months after starting treatment or changing the regimen until complete remission or low activity (1A); when the disease is in remission or low disease activity, follow-up can be performed every 3 to 6 months (4D). Failure to achieve disease remission or low disease activity after 6 months of combined therapy with two standard cDMARDs at appropriate doses is considered a failure of cDMARD therapy (1A); one of the drugs considered a failure of cDMARD therapy must be MTX, unless MTX is contraindicated (1A). Biologic disease-modifying antirheumatic drugs (bDMARD) When cDMARD therapy is inadequate or intolerant, bDMARD therapy is available. (1A) bDMARD may be used early in patients with active disease and poor prognostic factors or when cDMARD cannot be used.(4D) Information should be obtained on the presence of active or presenting infections, co-morbidities, vaccinations, pregnancy and possible contraindications before treatment with bDMARD (1A); screening for tuberculosis, hepatitis B and C should be performed before bDMARD treatment. Conditions in which bDMARD should be avoided include: acute and chronic infections, including joint infections within the past 12 months; solid or hematologic tumors (except basal cell carcinoma treated and in remission for more than 5 years); precancerous lesions; demyelinating lesions; severe cardiac insufficiency (FC III or IV); pregnancy and lactation; and low gammaglobulin or immunosuppressed individuals (low CD4 and CD8 counts). (3-4, C-D) Hepatitis virus vaccination at least 4 weeks prior to bDMARD therapy. (3-4, C-D) bDMARD is more effective in combination with MTX therapy (1A); if MTX is contraindicated or intolerant, other cDMARD should be combined (1A). Options for bDMARD include tumor necrosis factor-α (TNF-α) inhibitors, abciximab, rituximab, and tolimumab (1A); 6 months of treatment with one bDMARD without remission may lead to conversion to another bDMARD (3C); dose reduction may be considered when remission is achieved (1A); more than 12 months of remission may lead to consideration of discontinuation of bDMARD (2B) Use of bDMARD in special circumstances TB screening is recommended before bDMARD treatment for tuberculosis (2B); all potentially TB-infected patients should receive prophylactic antituberculosis treatment (2B); active TB should be considered only after adequate treatment with bDMARD (3C). Screening for hepatitis B and C should be performed prior to bDMARD treatment for viral hepatitis (4D); bDMARD should be avoided in patients with active or untreated chronic hepatitis B and active hepatitis C. Other active infections are contraindications to bDMARD treatment (1A); when co-infection is clinically suspected, bDMARD treatment should be discontinued and appropriate consultation should be performed (1A). When a comorbid tumor is suspected, a patient-specific analysis should be made and the decision should be discussed with the oncologist and the patient (4D); when facing elective larger surgery, bDMARD should be discontinued for 2 to 4 half-lives before surgery (2B). Pregnancy and breastfeeding should be avoided during bDMARD treatment, and contraception is strongly recommended for women of childbearing age (4D). Vaccinations should be administered at least 4 weeks prior to bDMARD treatment, and live or attenuated vaccines are absolutely contraindicated during treatment.