14 October 2025
The upcoming guideline from the British Society for Rheumatology will replace the previous version from 2019 to provide up-to-date and evidence-based recommendations for the safe use of biologic and targeted synthetic DMARDs (b/tsDMARDs) in individuals with inflammatory arthritis (IA) across the life course. The updated guideline will inform healthcare professionals involved in the management of IA, as well as people with IA, their families, their carers, and charitable organisations.
Important updates will include:
- The incorporation of newer pharmacotherapies that have become available since the last guideline such as IL-17 inhibitors, IL-23 inhibitors, and Janus kinase inhibitors (JAKi).
- New recommendations on b/tsDMARD prescribing choices following screening for the risk of drug-induced lupus, infections, malignancy, venous thromboembolism, and cardiovascular disease.
- Updated guidance on the timing of vaccination and surgery for people with IA receiving b/tsDMARD
Describing how the whole life course will be covered, guideline working group (GWG) Chair, Dr Christopher Holroyd, said
“While the existing 2019 guideline provided safety recommendations for the use of bDMARDs in adults with IA, no equivalent guidance exists for children and young people with juvenile idiopathic arthritis. The updated guideline will include an extension of the target clinical population to cover children and young people with inflammatory arthritis to ensure everyone will be supported. In addition, the guideline is being updated to reflect newer pharmacotherapies that have since become available and new emerging evidence that offers valuable insights into b/tsDMARD treatment, monitoring and safety that will support us in clinical practice.”
The GWG includes experts from across the whole multi-professional team with representatives across adult and paediatric care, as well as experts by experience.
Alan Rawlings discusses the role of experts by experience in the guideline working group:
“Experts by experience can greatly influence the way the subsequent guidelines are worded and directed. All guidelines are being written for patients as well as health professionals, and it is our duty as experts by experience to ensure that our fellow patients can make some sense of the highly technical stuff that will be included in the final version of the b/tsDMARDs guideline.”
- The full guideline is expected to be published in 2026.