At the annual meeting of EULAR (the European League Against Rheumatism), which was held in June, it was announced that new guidelines for the treatment of rheumatoid arthritis will be published. The new guidelines will update the 2010 EULAR recommendations and will be more general than 2012 rheumatoid arthritis guidelines issued by the American College of Rheumatology.
While the new EULAR guidelines are not yet published, some aspects were released prior to publication. Here are some of the important points:
- Methotrexate, a DMARD (disease-modifying anti-rheumatic drug) is an effective first-line therapy for rheumatoid arthritis. DMARDs may be used early in the course of the disease and may be used alone or in combination. If a patient fails to achieve a satisfactory response with the initial DMARD tried, another DMARD may be tried or the patient may be moved to a biologic drug, depending on the patient's prognosis.
- All approved biologics are considered similar in effectiveness. It is not necessary for the next step after methotrexate to be a TNF blocker.
- It is preferred that biologic drugs be used in combination with methotrexate as opposed to being used alone.
- Xeljanz (tofacitinib) is recommended after two biologic failures.
- Low-dose glucocorticoids (i.e., prednisone) may be part of a treatment regimen but should be tapered within 6 months.
When the guidelines are published, we will cover more of the recommendations. Stay tuned.
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