Clinical Recommendations of the Qazaq College of Rheumatology for the Diagnosis and Treatment of Rheumatoid Arthritis: 2025 National Initiative

Rheumatoid arthritis (RA) remains a major cause of disability and reduced quality of life worldwide [1], with notable differences in disease management across regions. In Kazakhstan, the increasing burden of RA [2] and the need for harmonized care have led to the development of the country's first comprehensive national clinical recommendations for the diagnosis and treatment of RA under the leadership of the Qazaq College of Rheumatology (QCR) in 2025. The QCR 2025 recommendations were developed by a national expert panel integrating international evidence with local epidemiological data and clinical experience from rheumatology centers across the country. The recommendations are aligned with the 2022 EULAR and 2021 ACR guidelines while addressing clinical priorities specific to Kazakhstan. Consistent with EULAR and ACR principles, the QCR recommendations emphasize treat-to-target strategies, regular monitoring of disease activity (DAS28), and shared decision-making between clinicians and patients. At the same time, the initiative highlights issues of particular relevance to Kazakhstan and other countries in Central Asia. For example, the management of latent tuberculosis infection (LTBI) remains critical in a country with an intermediate TB burden. The new recommendations outline clear screening and prophylactic treatment pathways developed in collaboration with infectious disease specialists. Likewise, viral hepatitis B and C, prevalent in the region, are addressed with guidance on safe use of csDMARDs, bDMARDs, and tsDMARDs in affected patients. In pregnant patients, the recommendations adapt EULAR guidance to local practice, supporting the use of sulfasalazine, glucocorticoids, and selected TNF inhibitors during pregnancy and lactation, while strictly avoiding teratogenic agents such as methotrexate and leflunomide. The QCR guidelines also encourage integration of RA management into Kazakhstan's national digital health strategy, including expansion of national RA registries to collect real-world data and improve health system planning [7]. This experience of adapting international recommendations to local conditions may provide a useful model for other countries in Central Asia, Eastern Europe, and low- and middle-income regions. The development of national clinical recommendations represents an important milestone in improving the quality of RA care in Kazakhstan and contributes to global efforts to ensure equitable access to evidence-based rheumatologic treatment for all patients. G.T.: conceptualization, writing – project administration, original draft preparation, review and editing. A.T.: methodology, literature search, writing. G.G.: data curation, formal analysis. Z.A.: visualization, validation, clinical expertise. B.E.: evidence verification and pharmacological expertise. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. No new data were generated or analyzed for this article. Data sharing is not applicable.