Clinical recommendation	Evidence rating	References
Patients with rheumatoid arthritis should be treated as early as possible with DMARDs to control symptoms and delay disease progression.	A	2,14,15
Patients with persistent inflammatory joint disease (longer than six to eight weeks) already receiving analgesics or NSAIDs should be considered for rheumatology referral, preferably within 12 weeks.	C	13,14
Patient education, preferably one-to-one, should be provided when rheumatoid arthritis is diagnosed.	C	29
NSAIDs should be prescribed in the lowest dose that provides symptom relief and should be cut back after a good response to DMARDs is achieved.	A	13
Gastroprotection should be used if patients are older than 65 years or have a history of pepticulcer disease.	B	13
Intra-articular corticosteroid injections can be helpful but should not be administered more than three times in one year.	C	13
Low-dose oral corticosteroids are effective for symptom relief but have a high risk of toxicity; therefore, the lowest dosage possible should be used for the shortest period possible.	A	2
Combination therapy may be more effective than treatment with one drug alone.	A	2,16–18
Efficacy of treatment should be monitored; changes in hemoglobin, erythrocyte sedimentation rate, and C-reactive protein may indicate treatment response, and measurement instruments such as the European League Against Rheumatism response criteria are useful for tracking disease progression.	C	2,35
A multidisciplinary team approach is beneficial, at least in the short term; therefore, patients should have access to a wide range of health care professionals, including their primary care physicians, rheumatologists, nursing specialists, physical therapists, occupational therapists, dietitians, podiatrists, pharmacists, and social workers.	C	30
Exercise is beneficial for aerobic capacity and muscle strength with no detrimental effects on disease activity or pain levels.	C	28