[Treatment algorithm for rheumatoid arthritis : According to the S2e guidelines 2018]

Area of Science:

• Rheumatology
• Immunology
• Pharmacology

Background:

• Active rheumatoid arthritis (RA) necessitates treatment with disease-modifying antirheumatic drugs (DMARDs).
• Methotrexate is the established first-line therapy for RA.
• The treat-to-target principle guides RA management.

Purpose of the Study:

• To outline the recommended treatment strategies for active rheumatoid arthritis.
• To define therapeutic goals and response criteria.
• To describe treatment adjustments based on patient response and disease progression risk.

Main Methods:

• Adherence to the treat-to-target principle.
• Initial treatment with methotrexate.
• Evaluation of treatment response at 12 weeks using composite scores (e.g., DAS28, SDAI).
• Consideration of alternative DMARDs (csDMARDs, bDMARDs, tsDMARDs) based on disease severity and risk factors.

Main Results:

• Therapeutic aim is remission (SDAI ≤3.3 or Boolean criteria) or low disease activity.
• A 50% improvement in composite scores indicates a measurable response at 12 weeks.
• Treatment modification is indicated if therapeutic goals are not met.

Conclusions:

• Methotrexate is the preferred initial DMARD for active RA.
• Regular monitoring and treatment adjustments are crucial for achieving remission or low disease activity.
• Sequential or alternative DMARD strategies, including bDMARDs and tsDMARDs, are essential for managing RA effectively.