11
Figure 1. Rheumatoid Arthritis Pharmacologic Management
DMARD-Naïve
Low Disease
Activity
Moderate or
High Disease
Activity
Moderate or
High Disease
Activity
csD less than 3 mos > over 3 mos
Treat to
Target
DMARDs, disease modifying anti-rheumatic drugs [csD, conventional synthetic DMARD;
bD, biologic DMARD; tsD, targeted synthetic DMARDs]; GC, glucocorticoid; HCQ,
hydroxychloroquine; SSZ, sulfasalazine; TNFi, tumor necrosis factor inhibitor; TTT, treat to
target; >, preferred over
MTX (LEF, dual or triple
csD, MTX + TNFi) > (HCQ,
SSZ, bD or tsD, MTX +
non-TNFi bD or tsD)
HCQ
(SSZ>MTX>LEF)
Moderate-High Disease Activity Persists
Add a bDMARD or a tsDMARD to MTX
Moderate-High Disease Activity Persists
Switch bD or tsD class
Moderate-High Disease Activity Persists
Change DMARD > continued GC
