What are the EULAR guidelines for pharmacologic therapy in rheumatoid arthritis (RA)?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

The 2016 update of the EULAR RA management guidelines includes the following key recommendations for pharmacologic therapy [5] :

  • Therapy with disease-modifying antirheumatic drugs (DMARDs) should be started as soon as the diagnosis of RA is made.  (Level of evidence: Ia; grade of recommendation: A)
  • The primary target for treatment should be sustained remission or low disease activity. (Level of evidence: Ia; grade of recommendation: A)

  • Patients with active disease should be monitored every 3 months, and treatment should be adjusted if they have no improvement at 6 months (Level of evidence: IIb) 

  • Methotrexate (MTX) is recommended as first-line therapy; sulfasalazine (SSZ) or leflunomide can be substituted if there are contraindications to MTX (Level of evidence: Ia; grade of recommendation: A)

  • Short-term glucocorticosteroids should be considered when initiating or changing DMARDs, in different dose regimens and routes of administration, but should be tapered as rapidly as clinically feasible. (Level of evidence: Ia; grade of recommendation: A)

  • If the treatment target is not achieved with the first DMARD strategy, when poor prognostic factors are present, addition of a tumor necrosis factor (TNF) inhibitor (eg, adalimumab, certolizumab, etanercept, golimumab and infliximab), abatacept, tocilizumab, or JAK-inhibitors (where approved) should be considered. (Level of evidence: Ib; grade of recommendation: A)


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