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
Treatment
...Principles RA requires early evaluatio...
...Initiation...
...of treatment in DMARD-naive patients with...
...oroquine. (Strong, Very Low)578...
...asalazine. (Strong, Lo...
...ARD (Strong, Very Low)578
...therapy. (Strong, Moderate)578...
...of methotrexate plus a non-TNF inhibitor bDMARD...
...Strong, Very Low)c The direction of th...
...de (Conditional, Low)578...
...csDMARD therapyc (Conditional, Moderate)578...
...f methotrexate plus a TNF inhibitorc. (Co...
...iation of a csDMARD without short-te...
...of a csDMARD without longer-term (≥3 mont...
...ion of treatment in DMARD-naive patients with...
...droxychloroquine is conditionally r...
Sulfasalazine is conditionally rec...
...is conditionally recommended over leflun...
...of treatment in csDMARD treated, but met...
...Conditional, Moderate)578...
...(Conditional, Very Low)578...
...The first certainty of evidence applies to the f...
...xate Administration...
...patients initiating methotrexate, ora...
...15 mg within four to six weeks is conditionally...
...dose of less than 15 mg.a (, Very Low)578...
...s not tolerating oral methotrexate, split do...
...r patients taking oral methotrexate...
...s recommendation refers only to the initial...
...nt Modification...
...patients who have not been previously...
...or patients who have had an inadequate response...
...inimal initial treatment goal of low disease act...
...patients taking maximally tolerated doses...
...nts taking a bDMARD or tsDMARD who...
...ing glucocorticoids to remain at target, ad...
...ients taking DMARDs who are not at target...
Tapering DMARD...
...tion of all DMARDs at their current dose is...
...ion is conditionally recommended over gradual disc...
...ual discontinuation is conditionally re...
...patients taking triple therapy who wish...
...wish to discontinue a DMARD, gradual discontinu...
...Patient Populations...
Subcutaneous No...
...tients with subcutaneous nodules who...
...ents taking methotrexate with progres...
...monary Disease...
...ith clinically diagnosed mild and stable ai...
...art Failure
...tients with NYHA class III or IV heart failure a...
...king a TNF inhibitor who develop hear...
...oproliferative Disorder
...tients with a previous lymphoproliferative dis...
...atitis B...
For patients initiating rituximab...
...nts initiating any bDMARD or tsDMARD who are...
For patients initiating a bDMARD other than ritu...
...nalcoholic Fatty Liver Disease (NAFL...
...¯ve patients with NAFLD, normal liver...
...tent Hypogammaglobulinemia without...
...ing of persistent hypogammaglobulinemia withou...
...revious Serious Infec...
...with a serious infection within the previo...
...r patients with a serious infection within the pr...
...culous Mycobacterial (NTM) Lung disease...
...with NTM lung disease, use of the lowest poss...
...atients with NTM lung disease, who hav...
...ts with NTM lung disease, who have modera...
...7. DMARDsHaving trouble viewing table? Expand...
...atoid Arthritis Pharmacologic Management...