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.