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ACR Rheumatoid Arthritis RA Guidelines

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Key Points 2 Table 2. Agents Used in Treating RA Drug Category Definitions Methotrexate (MTX) A disease modifying antirheumatic drug (DMARD) Used either oral or subcutaneous DMARDs a Traditional/conventional DMARDs including hydroxychloroquine (HCQ), leflunomide (LEF), methotrexate or sulfasalazine (SSZ) (excludes azathioprine, cyclosporine, minocycline and gold b ). It does not include tofacitinib, which is considered separately. DMARD monotherapy Most oen defined as the use of MTX monotherapy, but may also be SSZ, HCQ, or LEF Double DMARD therapy MTX+SSZ, MTX+HCQ, SSZ+HCQ, or combinations with LEF Triple DMARD therapy MTX+SSZ+HCQ DMARD combination therapy Double or triple traditional/conventional DMARD therapy Tofacitinib Oral synthetic small molecule Biologics TNFi biologic or non-TNF biologic (excludes anakinra a ) TNFi biologics Adalimumab, certolizumab pegol, etanercept, golimumab or infliximab Non-TNF biologics Abatacept, rituximab or tocilizumab (excludes anakinra a ) Low dose glucocorticoid ≤10 mg/day of prednisone (or equivalent). High dose glucocorticoid >10 mg/day of prednisone (or equivalent) and ≤60 mg/day with a rapid taper (e.g., COBRA regimen 6 ) c Short-term glucocorticoid <3 month treatment a Anakinra was considered but not included in these guidelines due to its infrequent use in RA and lack of new data since 2012. b Azathioprine, cyclosporine, minocycline and gold were considered but not included in these guidelines due to their infrequent use in RA and/or lack of new data since 2012. c Regimen based on that described in the Combinatietherapie Bij Ruematoide Artritis (COBRA). 5

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