Rheumatoid Arthritis Treatment Guidelines Updated
THURSDAY, June 26 (HealthDay News) -- New recommendations for the use
of disease-modifying anti-rheumatic drugs (DMARDs) in the treatment of
rheumatoid arthritis (RA) have been developed by the American College
of Rheumatology.
The recommendations on the use of non-biologic and biologic DMARDs in
RA address five key areas: indications for use; monitoring for side
effects; assessing clinical response; screening for tuberculosis (a
risk factor associated with biologic DMARDs); and under certain
circumstances (i.e. high disease activity) the roles of cost and
patient preference in choosing biologic agents.
The recommendations, published in the June issue of the journal
Arthritis Care & Research, also take into account RA disease duration,
disease severity, and prognostic features.
"These recommendations were developed for specialist clinicians
familiar with assessing RA disease activity and disease severity,"
project co-leader Dr. Kenneth Saag, professor of medicine and
epidemiology at the University of Alabama at Birmingham, said in a
prepared statement.
"Applying these recommendations to clinical practice requires
individualized patient assessment and clinical decision-making. The
recommendations developed are not intended to be used in a 'cookbook'
or prescriptive manner or to limit a physician's clinical judgment,
but rather to provide guidance based on clinical evidence and expert
panel input," Saag said.
The recommendations include:
Methotrexate or leflunomide therapy is recommended for most RA
patients.
Methotrexate plus hydroxychloroquine is endorsed for patients with
moderate to high disease activity.
The triple DMARD combination of methotrexate plus hydroxychloroquine
plus sulfasalazine for patients with poor prognostic features and
moderate to high levels of disease activity.
Prescribing anti-TNF agents -- etanercept, infliximab, or adalimumab
-- along with methotrexate in early RA (less than 3 months) only for
patients with high disease activity who had never received DMARDs. In
intermediate- and longer-duration RA, anti-TNF agents are recommended
for patients who had failed to respond adequately to methotrexate
therapy.
Reserving the fusion protein abatacept and the B-cell antibody
rituximab for patients with at least moderate disease activity and
poor disease prognosis for whom methotrexate in combination with or
sequential administration of other nonbiologic DMARDs led to an
inadequate response.
Avoiding the initiation or resumption of treatment with methotrexate,
leflunomide, or biologic agents for patients with active bacterial
infection, active herpes-zoster viral infection, active or latent
tuberculosis, or acute or chronic hepatitis B or C.
Not prescribing anti-TNF agents to patients with a history of heart
failure, with a history of lymphoma, or with multiple sclerosis or
demyelinating disorders.
Avoiding the initiation or resumption of methotrexate, leflunomide, or
minocycline for RA patients planning for pregnancy and throughout the
duration of pregnancy and breastfeeding.
"These recommendations are extensive but not comprehensive, and it is
intended that they will be regularly updated to reflect the rapidly
growing scientific evidence in this area along with changing practice
patterns in rheumatology," Saag said.
SOURCE: American College of Rheumatology, news release, June 3, 2008
Publish Date: June 26, 2008
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