ACR Updates Guidelines for Rheumatoid Arthritis Treatment

This article was originally published in RheumatologyNetwork.

The American College of Rheumatology (ACR) has released new guidelines on the treatment of rheumatoid arthritis, including 44 treatment recommendations, 7 of which are considered strongly recommended.

Included in the guidelines are new recommendations on the administration of methotrexate, treat-to-target for patients naïve to biologic disease modifying anti-rheumatic drugs (bDMARDs) or targeted synthetic DMARDS (tsDMARDs), and prophylactic antiviral therapy for patients initiating rituximab who are hepatitis B core antibody positive.

In accordance with the ACR guidelines, methotrexate monotherapy is strongly recommended as a treatment over bDMARD or tsDMARD monotherapy for DMARD-naïve patients with moderate-to-high disease activity. The treatment is also strongly recommended for this patient population over methotrexate plus a non-TNF inhibitor bDMARD or tsDMARD.

Methotrexate is also strongly recommended over hydroxychloroquine or sulfasalazine for DMARD-naïve patients with moderate-to-high disease activity.

Initiation of a csDMARD without longer-term (at least 3 months) glucocorticoids is now strongly recommended over initiation of a csDMARD with longer-term glucocorticoids for DMARD-naïve patients with moderate-to-high disease activity.

A treat-to-target approach is also strongly recommended over usual care for patients who have not been previously treated with bDMARDs or tsDMARDs.

Prophylactic antiviral therapy is now strongly recommended over frequent monitoring of viral load and liver enzymes alone for patients initiating rituximab who are hepatitis B core antibody positive, regardless of hepatitis B surface antigen status.

Finally, prophylactic antiviral therapy is strongly recommended over frequent monitoring alone for patients initiating any bDMARD or tsDMARD who are hepatitis B core antibody positive and hepatitis B surface antigen positive.