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Determining the best treatments for the right people in rheumatology.

While randomized controlled trials help identify efficacious treatments, they often do not answer critical questions about how to make treatment decisions in typical patients. Well described limitations of randomized controlled trials include their short duration, lack of headto-head comparison between relevant treatment strategies, exclusion of patients at high risk of adverse events, and lack of guidance about subgroups of patients. With a growing number of useful treatments in rheumatology and rheumatoid arthritis (RA) in particular, clinicians and patients are looking to optimize care by better understanding comparative safety and effectiveness in relevant subgroups. Newer pragmatic designs and ‘strategy’ trials will help answer some of these questions, but careful observational studies can offer information for patients and clinicians looking for relevant treatment data. The group of reviews in this issue focus on areas that should enhance our understanding of best treatments and best practice in rheumatology, with a focus on RA.