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Updated Guidelines for RA Treatment

In 2008, the American College of Rheumatology (ACR) issued guidelines for the use of non-biologic and biologic treatments in rheumatoid arthritis (RA). Much has changed in the years since the last recommendations, with the availability of new drugs and increased experience with the older agents. The ACR guideline update, which was published in the May 2012 issue of Arthritis Care & Research, focuses on early treatment, special considerations for high-risk patients, and screening for tuberculosis. “The 2012 update re-emphasizes the importance of more aggressive treatment in early RA.” The ACR update re-emphasizes the importance of aggressive treatment in early RA. In addition to better outcomes, early intensive treatment can help patients maintain physical function and quality of life. Prevention is critical because joint damage resulting from RA is permanent once it occurs. It should be noted that the updated recommendations focus on common clinical scenarios. They should be used as a guide for clinicians with the clear understanding that the best treatment decisions can only be made by having collaborative dialogue with patients. For each patient, physicians must consider: The risks and benefits of treatment. Comorbidities and concomitant medications. Patient preferences. Practical economic considerations. Rheumatoid Arthritis Treatment Recommendations The goal of early RA treatment is for remission or at least low disease activity. For patients who have been symptomatic for 6 months or less, the usual approach should be disease-modifying antirheumatic drug (DMARD) monotherapy. If disease activity is moderate or high and patients have poor prognosis, combination DMARD therapy can be tried. If disease activity is high in early RA and the prognosis is poor, an anti-tumor necrosis factor...

An RA Update

In the June 15, 2008 issue of Arthritis Care & Research, the American College of Rheumatology (ACR) published updated guidelines on the use of nonbiologic disease-modifying anti-rheumatic drugs (DMARDs) for the treatment of rheumatoid arthritis (RA). The guidelines also provide recommendations for the use of biologic agents for the first time. The ACR recommendations are the culmination of a systematic review of evidence that updates guidelines that were previously released in 2002. They were developed for specialists who are familiar with assessing RA activity and disease severity. Assessing DMARD Therapies  The ACR recommendations provide evidence-based suggestions for when to initiate biologic and nonbiologic DMARDs. Recommendations should be based on the level of disease activity, duration of RA, and factors that pertain to prognosis. Nonbiologic DMARD combinations recommended in the guidelines and used most commonly include methotrexate plus hydroxycholoroquine, methotrexate plus sulfasalazine, methotrexate plus leflunomide, sulfasalazine plus hydroxychloroquine, and sulfasalazine plus hydroxychloroquine followed by methotrexate. Monotherapy with either methotrexate or leflunomide, however, is recommended as initial therapy for most patients with RA for all disease durations and degrees of disease activity. Biologic therapies have assumed a significant role in the treatment of RA, particularly for patients with severe RA and high disease activity after failure of nonbiologic DMARDs. The updated guidelines recommend appropriate times to consider biologics and provide safety considerations that should be recognized when using these therapies. Biologic DMARDs are separated according to disease duration (less than 6 months and 6 months or longer). Patients with early RA and only low or moderate disease activity are not considered candidates for biologic therapy....
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