Journal
RHEUMATOLOGY
Volume 51, Issue -, Pages V48-V54Publisher
OXFORD UNIV PRESS
DOI: 10.1093/rheumatology/kes122
Keywords
biologic agents; clinical remission; rheumatoid arthritis treatment
Categories
Funding
- F. Hoffmann-La Roche Ltd.
- Roche
- UCB
- Abbott
- Merck
- Pfizer
- BMS
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RA is defined by the interrelated triad of disease activity, joint damage and disability. Although disease activity and its associated disability are reversible, joint damage and its associated disability are not. Thus, an important goal of RA therapy is to maximally reduce disease activity and thereby mitigate the accumulation of irreversible joint damage. Treatment for patients with RA should be initiated early and aggressively, with frequent assessments and a goal of achieving remission as quickly as possible after treatment initiation. We propose a treatment algorithm that recommends early and aggressive therapy with high-dose MTX therapy (15-25 mg/week), which may include moderate doses of glucocorticoids. The goal is to achieve low disease activity (determined by a composite measure that includes joint counts) within 3-6 months. If low disease activity is not achieved by 6 months, another conventional DMARD or a biologic agent should be added to the treatment regimen or patients should be switched to another DMARD plus a glucocorticoid. Once low disease activity is achieved, the treatment goal for the ensuing 3-6 months becomes disease remission.
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