Treatment Guidelines in Rheumatoid Arthritis

Rheumatoid arthritis is the most common autoimmune, destructive, inflammatory arthritis in adults. Effective treatments include oral conventional synthetic disease-modifying antirheumatic drugs (DMARDs; eg, methotrexate), injectable biologic DMARDs, and targeted synthetic DMARDs (oral). Key recommendations are to start effective treatment immediately with DMARDs to reduce disability; use effective doses of methotrexate (oral or subcutaneous) with folic acid as the initial treatment; rapidly escalate treatment with various DMARDs, if methotrexate alone is not effective in controlling rheumatoid arthritis; and aim for a treat-to-target strategy with a goal of low disease activity or remission by frequently monitoring disease activity and escalating treatment.