7
Table 5. Tapering DMARDs
Recommendations
Certainty of
Evidence
Continuation of all DMARDs at their current dose is conditionally
recommended over dose reduction of a DMARD.
Low
Dose reduction is conditionally recommended over gradual
discontinuation of a DMARD.
Low
Gradual discontinuation is conditionally recommended over abrupt
discontinuation of a DMARD.
Low
For patients taking triple therapy who wish to discontinue a
DMARD, gradual discontinuation of sulfasalazine is conditionally
recommended over gradual discontinuation of hydroxychloroquine.
Very low
For patients taking methotrexate plus a bDMARD or tsDMARD
who wish to discontinue a DMARD, gradual discontinuation
of methotrexate is conditionally recommended over gradual
discontinuation of the bDMARD or tsDMARD.
Very low
Table 6. Specific Patient Populations
Recommendations
Certainty of
Evidence
Subcutaneous Nodules
For patients with subcutaneous nodules who have moderate to high
disease activity, methotrexate is conditionally recommended over
alternative DMARDs.
Very low
For patients taking methotrexate with progressive subcutaneous
nodules, a switch to a non-methotrexate DMARD is conditionally
recommended over continuation of methotrexate.
Very low
Pulmonary Disease
For patients with clinically diagnosed mild and stable airway/
parenchymal lung disease who have moderate to high disease activity,
methotrexate is conditionally recommended over alternative
DMARDs for the treatment of inflammatory arthritis.
Very low
