RA 2021 ACR Guidelines - Misc Flashcards
What to do with subcutaneous nodules>
MTX over alternative DMARDS
progressive SC nodules, switch to non-MTX DMARD over continuation of MTX
Pulmonary disease (mild + stable airway or parenchymal lung disease)
MTX over alternative DMARDs
Heart Failure (NYHA Class III or IV + low response to csDMARDs)
non-TNFi or tsDMARD over TNFi
on TNFi + develop heart failure
switch to non-TNFi or tsDMARD over continuation of TNFi
Lymphoproliferative disorder
rituximab (RTX) over other DMARDs (if RTX is approved)
NAFLD
in normal liver enzymes and LFTs with no advanced fibrosis –> MTX over alternative DMARDs
HEP B
prophylactic antiviral Rx over monitoring for pts:
- on RTX who are Heb B core antibody+
- on bDMARD or tsDMARD who are Hep B core antibody+ and Hep B surface Ag+
frequent monitoring over prophylactic antiviral rx for bDMARD other than RTX or tsDMARD with Hep B core antibody + and HBSAg
Hypogammaglobulinemia w/o infection
continue RTX over switching to different DMARD
Previous serious infection (w/in past 12 months)
add csDMARD over bDMARD or tsDMARD
add/switch DMARD over initiation/increase of GC
Non-tuberculosis mycobacterial lung disease
lowest dose of GC or d/c over continuation of GC
csDMARD over bDMARD or tsDMARD
abatacept over other bDMARD and tsDMARD
methotrexate administration
oral MTX recommended over SC (initiation)
initiation/titration to dose >/= 15mg/wk within 4 - 6 weeks (over a dose < 15 mg/wk)
if not tolerating oral MTX, split oral dose (over 24 hours) or SC, and/or increase dose of folic acid, is recommended over switching to alternate DMARDs
if not at target on oral MTX, switch to SC MTX over addition of/switching to alternative DMARDs
MAXIMIZE USE OF MTX PRIOR TO SWITCHING OR ADDING OTHER DMARDS
on triple therapy, if pt on both SSZ and HCQ and need to discontinue one, which is discontinued first?
SSZ
on MTX + bDMARD or tsDMARD who wish to d/c a DMARD…
…gradual discontinuation of MTX over gradual discontinuation of the bDMARD of tsDMARD
Low disease activity: HCQ recommended over…
…other csDMARD
Low disease activity: SSZ recommended over…
…MTX
