Key questions regarding the pharmacological treatment of patients with rheumatoid arthritis (RA).
| General RA treatment strategies |
| 1. What are the goals of treatment? |
| 2. What are poor prognostic features that should be measured at baseline to inform treatment decisions? |
| 3. How often should disease activity be monitored? |
| 4. How often should the treatment strategy be adjusted in patients with RA? |
| 5. How often should radiographs be ordered? |
| 6. Should therapy be changed in RA patients with adequate clinical response but with unequivocal x-ray progression? |
| Treatment with glucocorticoids |
| 7. What is the role of glucocorticoids in the management of RA? |
| Treatment with traditional DMARD (disease-modifying antirheumatic drugs) |
| 8. When should DMARD be started? |
| 9. Which DMARD should be used first? |
| 10. Which investigations should be ordered prior to starting treatment with MTX? |
| 11. What is the optimal dosing strategy for MTX? |
| 12. When should combination therapy with traditional DMARD be used? |
| 13. Which traditional DMARD combinations are preferred? |
| 14. Should leflunomide be used in combination with MTX? |
| Treatment with biologic DMARD |
| 15. In patients being considered for treatment with biologic DMARD, how should an inadequate response to traditional DMARD be defined? |
| 16. Which investigations should be ordered prior to starting treatment with biologic DMARD? |
| 17. Should MTX be coprescribed with biologic DMARD? |
| 18. When should anti-TNF therapy be used in the treatment of patients with RA? |
| 19. When should abatacept be used in the treatment of patients with RA? |
| 20. When should rituximab be used in the treatment of patients with RA? |
| 21. How should patients be retreated with rituximab? |
| 22. When should tocilizumab be used in the treatment of patients with RA? |
| 23. Which therapeutic strategy is recommended after failure of 1 anti-TNF? |
| 24. Which therapeutic strategy is recommended after failure of 2 anti-TNF? |
| 25. Which therapeutic strategy is recommended after failure of abatacept, rituximab, or tocilizumab? |
| 26. Should therapy be tapered or withdrawn in RA patients who achieve sustained remission? |
MTX: methotrexate; anti-TNF: tumor necrosis factor inhibitor.