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Updated Guidelines for RA Treatment

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The American College of Rheumatology (ACR) recently issued updated guidelines for the use of disease-modifying antirheumatic drugs (DMARDs) for people with rheumatoid arthritis (RA). Guidelines for these drugs were previously updated in 2008.

In a departure from the old recommendations, the ACR now stresses more intense therapy for people with early rheumatoid arthritis. Specifically, they recommend a traditional DMARD, such as methotrexate, for people with either low or high levels of disease activity -- the goal being to achieve remission.

Those with early rheumatoid arthritis and moderate to high disease activity -- as defined by frequent flare-ups and high levels of inflammatory markers in the bloodstream -- should also take a tumor necrosis factor (TNF) inhibitor. (Remicade [infliximab], a widely prescribed TNF inhibitor, should only be used in combination with methotrexate.)

Why the change? Joint damage from rheumatoid arthritis is largely irreversible and the rationale for early intensive therapy is backed by research suggesting that it is the most effective way to protect your joints and prevent long-term damage.

Other changes have been made regarding vaccinations, TB screening and the use of DMARDs in people with hepatitis B or C, heart failure or a history of cancer.

These guidelines were published in Arthritis Care and Research (Volume 64, page 625).

Posted in Arthritis on September 16, 2013


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