Title
Treatment of Rheumatoid Arthritis
Authoring Organization
Publication Month/Year
June 8, 2021
Last Updated Month/Year
November 7, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
To develop a new evidence‐based, pharmacologic treatment guideline for rheumatoid arthritis (RA).
Target Patient Population
Adult patients with rheumatoid arthritis (RA)
Target Provider Population
All clinicians who manage adult patients with rheumatoid arthritis (RA)
PICO Questions
At what dose and route of administration should methotrexate be started?
Does switching to non-methotrexate DMARDs improve tolerability over increasing the dose of folic acid, or using folinic acid or using split dose or subcutaneous dosing, for RA patients with side effects when taking methotrexate?
What is the efficacy of TTT in different patient populations (early versus late, bDMARD- or tsDMARD-exposed, elderly-onset, comorbidities)?
What is the optimal target and method of assessment of disease activity for TTT in different populations?
What is the comparative effectiveness/safety between bDMARDs and tsDMARDs?
What is the comparative effectiveness/safety between adding bDMARDs or tsDMARDs to methotrexate and switching to bDMARD or tsDMARD monotherapy?
What is the comparative effectiveness/safety between TTT by maximizing use of methotrexate (i.e., escalating dose via subcutaneous route) and adding/switching to bDMARD or tsDMARD monotherapy?
When, which, and how should DMARDs be tapered/discontinued?
Do clinical or biologic markers predict a differential response to DMARDs?
What is the effectiveness/safety of alternative treatment strategies in RA patients with clinical lung disease or NAFLD?
Which DMARDs can be initiated or continued after receiving checkpoint inhibitor therapy?
Which DMARDs should be used in patients with solid malignancies, including skin cancer?
Is there a time frame before which DMARDs can be started/resumed in patients with concomitant solid malignancies?
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Long term care, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Treatment, Prevention
Diseases/Conditions (MeSH)
D001172 - Arthritis, Rheumatoid
Keywords
rheumatoid arthritis, RA
Source Citation
Fraenkel L, Bathon JM, England BR, St Clair EW, Arayssi T, Carandang K, Deane KD, Genovese M, Huston KK, Kerr G, Kremer J, Nakamura MC, Russell LA, Singh JA, Smith BJ, Sparks JA, Venkatachalam S, Weinblatt ME, Al-Gibbawi M, Baker JF, Barbour KE, Barton JL, Cappelli L, Chamseddine F, George M, Johnson SR, Kahale L, Karam BS, Khamis AM, Navarro-Millán I, Mirza R, Schwab P, Singh N, Turgunbaev M, Turner AS, Yaacoub S, Akl EA. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2021 Jul;73(7):924-939. doi: 10.1002/acr.24596. Epub 2021 Jun 8. PMID: 34101387; PMCID: PMC9273041.