Fast Five Quiz: Rheumatoid Arthritis Management

Herbert S. Diamond, MD


June 10, 2020

Figure 1. Colored x-ray, rheumatoid arthritis.

The ACR Guideline for the Treatment of Rheumatoid Arthritis and the recently updated EULAR Recommendations for the Management of Rheumatoid Arthritis With Synthetic and Biological Disease-Modifying Antirheumatic Drugs recommend monotherapy with a csDMARD (eg, hydroxychloroquine [HCQ], leflunomide [LEF], methotrexate [MTX], sulfasalazine [SSZ]) as the initial treatment for newly diagnosed patients with early RA—regardless of the level of disease activity. Both the ACR and EULAR prefer MTX as the initial csDMARD therapy.

Biologic DMARDs (eg, tumor necrosis factor [TNF] inhibitors etanercept and infliximab, interleukin-6 receptor inhibitors sarilumab and tocilizumab, anti–B-cell [CD20] antibody rituximab) and tsDMARDs (eg, Janus kinase inhibitors baricitinib, tofacitinib, and upadacitinib) are not recommended until a patient demonstrates an insufficient response to a conventional agent.

With respect to newly diagnosed patients with RA who are intolerant to MTX or in whom contraindications to MTX exist, initial therapy may involve HCQ, LEF, or SSZ.

According to the Agency for Healthcare Research and Quality, combination therapy with MTX and SSZ has not been shown to provide greater efficacy than either drug alone.

Learn more about initial treatment recommendations for newly diagnosed patients with RA.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.