Rheumatoid Arthritis
Key Points
Key Points
- Initiating methotrexate early for the treatment of patients with moderate to high disease activity.
- Adjusting methotrexate to achieve maximal benefit prior to adding additional disease modifying anti-rheumatic drugs.
- Minimizing the use of glucocorticoids whenever possible.
- Implementing a treat to target (TTT) strategy.
Treatment
...reatment
...inciples RA requires early evaluation, diagnosi...
DMARD Initia...
...n of treatment in DMARD-naive patient...
...oxychloroquine. (Strong, Very Low)57...
...lazine. (Strong, Low)...
...MARD (Strong, Very Low)578...
...notherapy. (Strong, Moderate)578...
...ombination of methotrexate plus a non-T...
...ng, Very Low)c The direction of the...
...de (Conditional, Low)578...
...ual or triple csDMARD therapyc (Conditional, Mode...
Combination of methotrexate plus a TNF...
...ation of a csDMARD without short-term (...
...nitiation of a csDMARD without longer-term (≥3...
...nitiation of treatment in DMARD-nai...
...roxychloroquine is conditionally recommended...
...lfasalazine is conditionally recommended over meth...
...conditionally recommended over lefluno...
...f treatment in csDMARD treated, but methot...
...D (Conditional, Moderate)578...
...(Conditional, Very Low)c The direction of the...
...thotrexate Administra...
...nitiating methotrexate, oral methotrexate is c...
...15 mg within four to six weeks is conditionally r...
...less than 15 mg.a (, Very Low)578...
...ents not tolerating oral methotrexate, sp...
...atients taking oral methotrexate who...
...eatment Modification...
For patients who have not been previously...
...atients who have had an inadequate resp...
...minimal initial treatment goal of low disease...
...patients taking maximally tolerated...
...patients taking a bDMARD or tsDMARD...
...ents taking glucocorticoids to remain at target,...
...r patients taking DMARDs who are not at target...
...ering DMARD...
...nuation of all DMARDs at their curren...
...ion is conditionally recommended over...
...iscontinuation is conditionally recommended over...
...s taking triple therapy who wish to disc...
...to discontinue a DMARD, gradual discontinuation...
...ic Patient Populations...
...ubcutaneous Nodules
...ith subcutaneous nodules who have m...
For patients taking methotrexate with progressive...
Pulmonary Di...
...patients with clinically diagnosed...
...rt Failure...
...nts with NYHA class III or IV heart failure and an...
...ing a TNF inhibitor who develop he...
...roliferative Disorder...
...nts with a previous lymphoproliferative disorde...
...atitis B...
...s initiating rituximab who are hepatit...
...ts initiating any bDMARD or tsDMARD who are...
...ients initiating a bDMARD other th...
...Fatty Liver Disease (NAFLD)...
...DMARD naïve patients with NAFLD, norma...
...ersistent Hypogammaglobulinemia without Infection
...of persistent hypogammaglobulinemia without inf...
...us Serious Infection...
...with a serious infection within the previo...
...patients with a serious infection withi...
...ulous Mycobacterial (NTM) Lung d...
...r patients with NTM lung disease, use of th...
...ents with NTM lung disease, who have...
...patients with NTM lung disease, who have mod...
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...1. Rheumatoid Arthritis Pharmacologic Ma...