Rheumatology Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped rheumatology practice.

RA Treatment Strategy

Treat-to-target transforms outcomes

Pyramid → early MTX → treat-to-target (TICORA/BeSt) → bDMARDs → JAKi → ORAL Surveillance safety

Treat-to-target and CV safety

Acute-only → urate targets → febuxostat (CARES CV signal) → treat-to-target → pegloticase

Beyond cyclophosphamide

Cyclophosphamide (NIH) → Euro-Lupus low-dose → MMF (ALMS) → voclosporin (AURORA) → belimumab (BLISS-LN)

Steroid-sparing at last

High-dose steroids → GiACTA tocilizumab (2017) → steroid-sparing → relapse management

From NSAIDs to targeted therapy

NSAIDs only → anti-TNF (ATLAS/ABILITY) → IL-17 (MEASURE/PREVENT) → JAKi → nr-axSpA