RA- Treatment Guideline Flashcards
Step 1 of the RA algorithm
Figure out if the patient has low or moderate-high disease activity
What to start in a DMARD naive patient with low disease activity
HCQ monotherapy
What to start in a DMARD naive patient with mod-high disease activity
MTX monotherapy
Step 2 of the RA algorithm
Is the patient at the treat to target goal of low disease remission?
What to do when the patient is at the target of low disease remission
Continue the regimen
Continuing an RA regimen when the patient is at target: how long do they have to continue the treatment before you can decrease the dose or D/C?
At least 6 months
Continuing an RA regimen when target is met: what should you continue lifelong (ideally)
At least one DMARD to reduce risk of disease progression
Continuing an RA regimen when target is met: how to D/C a DMARD
Taper it!!!
Continuing an RA regimen: what to do if symptoms return and the DMARD’s been D/C’ed
Restart it
If patient is not at target: what to do if they’re not on MTX DMARD Tx
Switch to MTX
If patient is not at target: what to do if they’re taking MTX
Switch to SQ MTX
If patient not at target and they have no poor prognostic factors
Add a csDMARD
If patient not at target and they HAVE poor prognostic factors
Add a bDMARD or tsDMARD
Poor prognostic factors
Persistently moderate-high disease activity despite csDMARD
High acute phase reactant levels
High swollen joint count
Presence or RF and/or ACPA, especially at high levels
Presence of early erosions
Failure of two or more csDMARDs
Step 3 of the RA algorithm
If the patient didn’t meet the treat-to-target goal the first time- check to see if they did now
