What are the ACR treatment guidelines for early rheumatoid arthritis (RA)?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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In its 2015 revised guidelines for the management of RA, the American College of Rheumatology (ACR) included the following recommendations for treatment of early RA [4] :

  • A treat-to-target stategy should be used regardless of disease activity.  (Strong recommendation)
  • Low disease activity: DMARD monotherapy over double or triple therapy. MTCX is the preferred DMARD.  (Strong recommendation)
  • Moderate or high disease activity: DMARD monotherapy over double or triple therapy.  (Conditional recommendation)
  • Moderate /high disease activity despite DMARD monotherapy: Combination DMARDs  or  a  tumor necrosis factor (TNF) inhibitor  or  a non-TNF biologic agent (Strong recommendation)

A change from 2012 to 2015 guidelines is that the 2015 guidelines do not recommend initial combination DMARD therapy in early RA with moderate to high disease activity.

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