One of your best articles Jack! If I may, I would add two pitfall points: 1) to avoid hasty permanent discontinuation of a particular DMARD after a single infection (whether it be sinusitis, zoster, or other), and; 2) to address RA flares with a brief pred taper before prematurely declaring that a csDMARD or bDMARD has "lost effect." There seems to be a particular springtime flare season happening each year, where a brief pred taper regains control for my pts and averts the risk of playing musical chairs with DMARDs.