American College of Rheumatology Releases Rheumatoid Arthritis Treatment Guidelines for Patients with New or Early Diagnosis

The ACR 2015 Rheumatoid Arthritis (RA) treatment guidelines were published this week and released after nearly a year of review and revision by the panel. The guideline committee recommends that early rheumatoid arthritis (ERA) patients be treated in the following manner:

  • Use a “Treat-to-Target” strategy with the ideal target being low disease activity (LDA) or remission “as determined by the clinician and the patient.”
  •  Disease Modifying anti-Rheumatic Drug (DMARD)-naïve ERA patients with: Low Disease Activity: should receive DMARD monotherapy.  Moderate (MDA) or High Activity (HDA) should also receive DMARD monotherapy to begin with (over double or triple DMARD therapy).
  • Methotrexate (MTX) is the preferred initial therapy for most patients with early active RA.
  • ERA patients with MDA or HDA who have failed a DMARD should be treated with a combination of DMARDs or TNFi or a non-TNF biologic should be used, with or without methotrexate (MTX) in no particular order.
  • Biologic therapy should be used in combination with MTX when possible, owing to superior efficacy.
  • Low-dose glucocorticoids (prednisone ≤10 mg/day or equivalent) should be added in ERA patients who have moderate or high disease activity, despite any of the above DMARD or biologic therapies.
  • Low-dose glucocorticoids may also be used as bridge therapy until the benefits of DMARD therapy are evident.
  • Steroid dosing should be low and the duration of therapy short. Flares of RA: they recommend glucocorticoids (< 3 months of treatment) at the lowest possible dose for the shortest possible duration.

Source: American College of Rheumatology press release. 2015 ACR Guideline for the Treatment of Rheumatoid Arthritis Now Available Online. Nov. 10, 2015.

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