bDMARDs slightly increase the relative risk of SSI but not that of delayed wound healing after orthopedic surgery and should be used with appropriate caution.

We confirmed that the new CPG successfully addressed clinical issues that were important to both rheumatologists and patients. Clinicians should understand patients' reluctance to take medications and explain the role of each medication well to increase adherence.

Objectives This study aimed to evaluate patients’ opinions regarding their rheumatoid arthritis (RA) therapy and to reflect the patients’ perspectives in the 2020 update of the Japan College of Rheumatology clinical practice guidelines. Methods A self-administered questionnaire was mailed to 1600 members of the Japan Rheumatology Friendship Association, who were randomly selected by age and prefecture. Results A total of 1156 patients returned the questionnaire (response rate, 72.3%; mean age, 63.0 ± 11.9 years). Those who reported having discussed their treatment goals with their doctors (450 respondents, 38.9%) were more likely to be satisfied with their current medical care (odds ratio, 7.13; 95% CI 4.72–10.8) compared with those who had not discussed their goals nor had them explained (287 respondents, 24.8%). The benefits exceeded the adverse effects for all pharmacotherapy (methotrexate, corticosteroids, conventional synthetic antirheumatic drugs, biological agents, Janus kinase inhibitor, and anti-RANKL antibodies). However, while 74.2% of the respondents using biological agents perceived that ‘the favorable aspects outweighed the unfavorable aspects,’ most of those taking anti-RANKL antibodies (69.2%) felt uncertain. Conclusions The questionnaire successfully collected information regarding patients’ perceptions regarding their therapy. Further implementation of treat-to-target is necessary in Japan to improve patient satisfaction.

Using the GRADE approach, new CPGs successfully addressed important clinical issues for treating RA patients. Timely updating of recommendations should be routinely considered.

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