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Providers may be public, private, or a combination of both.Two-Tier: The government provides or mandates catastrophic or minimum insurance coverage for all residents (or citizens), while allowing the purchase of additional voluntary insurance or fee-for service care when desired.

Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at 50% improvement within 3 and target attainment within 6 months. Without unfavourable prognostic markers, switching to—or adding—another cs DMARDs (plus short-term GC) is suggested.

In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 cs DMARDs), any b DMARD (current practice) or Jak-inhibitor should be added to the cs DMARD.

An abundance of new information motivated us to now further update the EULAR recommendations for the management of RA with DMARDs.

After approval by the EULAR Executive Committee, the Convenor (JSS) and methodologist (RL) invited a Steering Committee and a Task Force to work on this update of the EULAR recommendations for the management of RA.

[2] The dates given are estimates, since universal health care arrived gradually in many countries.

In Germany for instance, government insurance programs began in 1883, but did not reach universality until 1941.

Despite the availability of many efficacious agents, treatment strategies that have been developed, and outcomes assessments that allow effective follow-up, the high costs of novel therapies have limited the widespread use of these therapeutic options, creating a significant extent of inequity.

Therefore, management recommendations on the approach to treating patients with RA have become increasingly useful in providing physicians, patients, payers, regulators and other healthcare suppliers with evidence-based guidance supported by the views of experts involved in many of these novel developments.

However, disease modification is the mainstay of RA treatment and constitutes an amalgam of characteristics: relief of signs and symptoms; normalisation—or at least important improvement—of impairment in physical function, quality of life and social and work capacity; and—as the foremost distinguishing characteristic of DMARDs compared with symptomatic agents—inhibition of structural damage to cartilage and bone.

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