4
Treatment
Table 4. Recommendations for Patients with Symptomatic
Early RA
Recommendations
Level of
Evidence
1. Regardless of disease activity level, use a treat-to-target strategy
rather than a non-targeted approach.
Low
2. If the disease activity is low, in patients who have never taken a
DMARD:
• use DMARD monotherapy (MTX preferred) over double
therapy.
Low
• use DMARD monotherapy (MTX preferred) over triple
therapy.
Low
3. If the disease activity is moderate or high, in patients who have never
taken a DMARD:
• use DMARD monotherapy over double therapy. Moderate
• use DMARD monotherapy over triple therapy. High
4. If disease activity remains moderate or high despite DMARD
monotherapy (with or without glucocorticoids), use combination
DMARDs or a TNFi or a non-TNF biologic (all choices with or
without MTX, in no particular order of preference), rather than
continuing DMARD monotherapy alone.
Low
5. If disease activity remains moderate or high despite DMARDs:
• use a TNFi monotherapy over tofacitinib monotherapy. Low
• use a TNFi + MTX over tofacitinib + MTX. Low
6. If disease activity remains moderate or high despite DMARD or Moderate
biologic therapies, add low-dose glucocorticoids. Low
7. If disease flares, add short-term glucocorticoids at the lowest possible
dose and for the shortest possible duration.
Very Low
See Table 9 for explanation of the Green and bolded and Yellow and italicized recommendations.
