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Review
. 2022 Aug;48(3):679-689.
doi: 10.1016/j.rdc.2022.03.005. Epub 2022 Jul 5.

Treatment Guidelines in Rheumatoid Arthritis

Jasvinder A Singh  1
Affiliations
Review

Treatment Guidelines in Rheumatoid Arthritis

Jasvinder A Singh. Rheum Dis Clin North Am. 2022 Aug.

Abstract

Rheumatoid arthritis is the most common autoimmune, destructive, inflammatory arthritis in adults. Effective treatments include oral conventional synthetic disease-modifying antirheumatic drugs (DMARDs; eg, methotrexate), injectable biologic DMARDs, and targeted synthetic DMARDs (oral). Key recommendations are to start effective treatment immediately with DMARDs to reduce disability; use effective doses of methotrexate (oral or subcutaneous) with folic acid as the initial treatment; rapidly escalate treatment with various DMARDs, if methotrexate alone is not effective in controlling rheumatoid arthritis; and aim for a treat-to-target strategy with a goal of low disease activity or remission by frequently monitoring disease activity and escalating treatment.

Keywords: Biologic; DMARD; Disease-modifying antirheumatic drug; Methotrexate; Recommendations; Rheumatoid arthritis; Treatment guidelines.

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Conflict of interest statement

Disclosure J.A. Singh has received consultant fees from Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two labs Inc, Adept Field Solutions, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, and Practice Point Communications; and the National Institutes of Health and the American College of Rheumatology. J.A. Singh has received institutional research support from Zimmer Biomet Holdings. J.A. Singh received food and beverage payments from Intuitive Surgical/Philips Electronics North America. J.A. Singh owns stock options in TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics Inc, Seres Therapeutics, Tonix Pharmaceuticals Holding Corp, and Charlotte’s Web Holdings, Inc. J.A. Singh previously owned stock options in Amarin, Viking, and Moderna Pharmaceuticals. J.A. Singh is on the speaker’s bureau of Simply Speaking. J.A. Singh is a member of the executive of Outcomes Measures in Rheumatology, an organization that develops outcome measures in rheumatology and receives arms-length funding from eight companies. J.A. Singh serves on the FDA Arthritis Advisory Committee. J.A. Singh is the chair of the Veterans Affairs Rheumatology Field Advisory Board. J.A. Singh is the editor and the Director of the University of Alabama at Birmingham Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. J.A. Singh previously served as a member of the following committees: member, the American College of Rheumatology's (ACR) Annual Meeting Planning Committee and Quality of Care Committees; the Chair of the ACR Meet-the-Professor, Workshop, and Study Group Subcommittee; and the co-chair of the ACR Criteria and Response Criteria subcommittee.