RA- Treat-to-Target Goals and Treatment Recommendations

Question 1

Goals of RA therapy

Answer 1

Treat-to-target approach with low disease activity as an acceptable target

Improve symptoms of joint pain and stiffness by reducing inflammation

Slow disease progression and prevent joint damage

Question 2

RA treatment principles

Answer 2

Initiate csDMARDs within 3 months of onset of persistent symptoms and assess efficacy q3months

Short-term glucocorticoids for bridging to DMARD onset

Step-up therapy if disease burden isn’t adequately controlled

Treat to target!

Question 3

Treat to target approach

Answer 3

Target low disease activity OR remission

Question 4

Comorbidities to consider: active TB

Answer 4

Avoid biologics and JAKis until treatment is complete

Question 5

Comorbidities to consider: latent TB

Answer 5

May use biologics after 1 months of starting TB treatment

Question 6

Comorbidities to consider: Hep B

Answer 6

Use caution with biologics and JAKis, screen first

Question 7

Comorbidities to consider: pregnancy

Answer 7

Avoid MTX and LEF

Question 8

Comorbidities to consider: HF

Answer 8

Avoid TNFi in NYHA Class III or IV
Non-TNFIs are preferred

Question 9

Comorbidities to consider: liver disease

Answer 9

Avoid MTX and LEF
Use caution with HCQ and SSZ

Question 10

Comorbidities to consider: lymphoproliferative disorder

Answer 10

Rituximab is preferred

Question 11

Vaccines to get BEFORE starting DMARD monoTx, DMARD combo Tx, TNFi biologics, and non-TNFi biologics

Answer 11

Pneumococcal
Inactive flu vaccine
Hep B
Recombinant HPV
Live herpes zoster

Get all of these at least 2 weeks prior to treatment

Question 12

Vaccines to get AFTER starting RA therapy

Answer 12

All of them…exception is live herpes vaccine if you’re on a TNFi biologic or non-TNFI biologic