Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020;58(6):390-400.
doi: 10.5114/reum.2020.101400. Epub 2020 Dec 23.

Conventional disease-modifying agents in rheumatoid arthritis - a review of their current use and role in treatment algorithms

Ivan Padjen  1 , Mirna Reihl Crnogaj  1 , Branimir Anić  1
Affiliations
Review

Conventional disease-modifying agents in rheumatoid arthritis - a review of their current use and role in treatment algorithms

Ivan Padjen et al. Reumatologia. 2020.

Abstract

Despite the development of targeted therapies, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) remain the cornerstone of treatment of rheumatoid arthritis (RA). A literature search was conducted on treatment recommendations and relevant papers regarding new insights on therapeutics in rheumatoid arthritis. Methotrexate is considered the "anchor drug" due to its high efficacy as monotherapy and in combination with other conventional and targeted agents. Leflunomide and sulfasalazine are sound alternatives, whereas (hydroxy)chloroquine is primarily used in combination with other csDMARDs. Their use is encouraged in all treatment phases - in combination with targeted agents, and with other csDMARDs. Combining different csDMARDs is especially attractive in lower income settings given the evidence proving (almost) equal efficacy and safety of the csDMARD combination approach compared to the combination of targeted agents with a csDMARD. The aim of this review is to provide a clinically oriented insight into the pharmacology of each csDMARD and their place in treatment algorithms.

Keywords: disease-modifying antirheumatic drug; leflunomide; methotrexate; rheumatoid arthritis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interests.

References

    1. Nell VP, Machold KP, Eberl G, et al. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford) 2004;43:906–914. doi: 10.1093/rheumatology/keh199. - DOI - PubMed
    1. Bijlsma JW. Disease control with glucocorticoid therapy in rheumatoid arthritis. Rheumatology (Oxford) 2012;51(Suppl 4):iv9–iv13. doi: 10.1093/rheumatology/kes086. - DOI - PubMed
    1. Smolen JS, van der Heijde D, Machold KP, et al. Proposal for a new nomenclature of disease-modifying antirheumatic drugs. Ann Rheum Dis. 2014;73:3–5. doi: 10.1136/annrheumdis-2013-204317. - DOI - PubMed
    1. Pincus T, Yazici Y, Sokka T, et al. Methotrexate as the “anchor drug” for the treatment of early rheumatoid arthritis. Clin Exp Rheumatol. 2003;21(5 Suppl 31):179–185. - PubMed
    1. Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020;79:685–699. doi: 10.1136/annrheumdis-2019-216655. - DOI - PubMed

LinkOut - more resources