Management of Rheumatoid Arthritis

➡️Poor prognostic factors

·   Persistently moderate or high disease activity (after csDMARDs therapy) according to composite measures including joint counts despite csDMARDs therapy.

·  High acute phase reactant levels.

·  High swollen joint count.

·  Presence of rheumatoid factor (RF) and/or anti-citrullinated peptide antibody (ACPA), especially at high levels.

·  Presence of early erosions.

·  Failure of 2 or more csDMARDs.

➡️Low dose glucocorticoids

·  <7.5 mg/day prednisone equivalent.

➡️Short-term

·  Up to 3 months.

➡️Tapering

·  Reduction of drug dose or increase of the interval between doses.

·  May include cessation (tapering to zero), but then only after slow reduction.

➡️Discontinuation, cessation

·  Stopping a particular drug.

➡️Disease activity states

·  Remission

ACR-EULAR remission definition (Boolean or index-based); sustained remission: ACR-EULAR-defined remission for ≥6 months

·   Low disease activity

Low disease activity state according to validated composite disease activity measures that include joint counts, performed by a healthcare professionals (HCP); sustained low disease activity: low disease activity for ≥6 months

·  Moderate, high disease activity

Respective disease activity state according to validated composite disease activity measures that include joint counts by a HCP.

➡️DMARD nomenclature

·  Conventional synthetic DMARDs: for example, Methotrexate, Leflunomide, Sulfasalazine, Hydroxychloroquine.

· Targeted synthetic DMARDs: for example, Baricitinib, Filgotinib, Tofacitinib, Upadacitinib.

·  Biological DMARDs: Biological originator DMARDs including

-   TNFi: Adalimumab, Certolizumab, Etanercept, Golimumab, Infliximab.

-   IL-6Ri: Sarilumab, Tocilizumab.

-   Co-stimulation-i: Abatacept.

-   Anti-B-cell (CD20): Rituximab.

·   Biosimilar DMARDs: currently for Adalimumab, Etanercept, Infliximab, and Rituximab.