An update on recommendations for the management of rheumatoid arthritis

This study investigated recent developments in the management of rheumatoid arthritis (RA). 

Rheumatoid arthritis (RA) is a chronic disease caused by inflammation. Inflammation causes painful swelling in the joints. Over time joint tissue degenerates and RA patients can become disabled. RA is treated with disease-modifying anti-rheumatic drugs (DMARDs). They can be synthetic (csDMARD) or biological (bDMARD). A new class of specific drugs is represented by targeted synthetic DMARDs (tsDMARDs). Managing RA is important to slow the progression of the disease.

The European League Against Rheumatism (EULAR) produces guidelines on managing RA. An updated EULAR guideline was recently published. The EULAR assessed all relevant information related to the management of RA. Recommendations were made.

Therapy with DMARDs should be started as soon as the diagnosis of RA is made. Treatment should aim to reach sustained remission (SR) or low disease activity (LDA). Monitoring should be frequent in active disease (every 1-3 months). Therapy should be adjusted If there is no improvement by 3 months. It should also be adjusted If SR or LDA has not been reached by 6 months.

Methotrexate (MTX; Otrexup) should be part of the first treatment strategy. Leflunomide (Arava) or sulfasalazine (Azulfidine) should be considered if a patient cannot take MTX. Short term glucocorticoids should be considered when starting or changing csDMARDs. The dose should be reduced as soon as possible. Another csDMARD should be considered if the first csDMARD is not effective. This should be considered in patients without poor prognostic factors (PPFs). PPFs are signs that the chance of RA worsening is greater. A bDMARD or tsDMARD should be considered in patients with PPFs. 

bDMARDs and tsDMARDs should be combined with a csDMARD. If a patient cannot tolerate a csDMARD then a specific type of bDMARD should be used. Drugs that block interleukin-6 (an inflammatory protein) and a tsDMARD is recommended. If a bDMARD or tsDMARD has failed, treatment with another bDMARD/tsDMARD should be considered.

bDMARDs or tsDMARDs can be reduced if SR is achieved. Reducing csDMARD treatment should also be considered if the patient is in SR.

This study investigated recent developments in the management of RA.

If you have any concerns regarding RA management please discuss with your doctor.