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 as the initial treatment for patients newly diagnosed with moderate to severe disease. Both the ACR and EULAR prefer MTX as the initial csDMARD therapy in moderate to severe cases.
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 or intolerance 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.
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Cite this: Herbert S. Diamond, Abhishek Nandan. Fast Five Quiz: Rheumatoid Arthritis Management - Medscape - Feb 22, 2023.