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When and how would I intensify an initial therapy of rheumatoid arthritis?
● Treatment goal is remission (DAS28 score <2.6) or low disease activity (<3.2) under continuing low-intensity therapy.
● In the absence of any major improvement after 4-6 weeks, first increase the first-line DMARD (if using methotrexate, first switch from oral to subcutaneous). If still insufficient after another 4-6 weeks, add one or more further DMARDs such as leflunomide, sulfasalazine, or hydroxychloroquine.
● If still insufficient after another 3 months, switch to methotrexate combined with an inhibitor of the TNF alpha, IL-6, or the CTLA-4 signaling. Second line option is the antibody against the B cell CD20 receptor rituximab.
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● In the absence of any major improvement after 4-6 weeks, first increase the first-line DMARD (if using methotrexate, first switch from oral to subcutaneous). If still insufficient after another 4-6 weeks, add one or more further DMARDs such as leflunomide, sulfasalazine, or hydroxychloroquine.
● If still insufficient after another 3 months, switch to methotrexate combined with an inhibitor of the TNF alpha, IL-6, or the CTLA-4 signaling. Second line option is the antibody against the B cell CD20 receptor rituximab.
≣
Karteninfo:
Autor: LWojnowski
Oberthema: Medicine
Thema: Pharmacology
Schule / Uni: University Clinical Center
Ort: Mainz
Veröffentlicht: 24.05.2013