RA - Treatment Guidelines

Question 1

What are the aims of treatment for RA?

Answer 1

Maintaining joint pain & swelling.
Prevent deformity & radiological dmg
Maintain QOL

Question 2

What treatment options are there for RA?

Answer 2

Analgesic - NSAIDs
cc
DMARDs
bDMARDs

Question 3

What is the Initial NG for the treatment of RA?

Answer 3

First line is MONOTHERAPY:
MTX
Leflunomide
Sulfasalazine
- Consider short term briding with glucocorticoid therapy when starting a new DMARD

Question 4

What is the Step up therapy of RA NG?

Answer 4

When treatment target is not achieved despite optimisation.
Add another CDMARD

Question 5

Once 2 CDMARD therapy doesnt work then what would you give?

Answer 5

bDMARD

Question 6

Moderate Disease (DAS28 3.2-5.1):

Answer 6

Anti-TNF:
- Adalimumab +/- MTX
- Etanercept +/- MTX
- Infliximab +/- MTX
tDMARDs (JAK–|):
- Filgotinib +/- MTX
- Upadacitinib +/- MTX
Anti-IL-6

Question 7

Severe Disease (DAS28 >5.1)

Answer 7

Anti-TNF:
- Adalimumab +/- MTX
- Etanercept +/- MTX
- Infliximab +/- MTX
tDMARDs (JAK–|):
- Filgotinib +/- MTX
- Upadacitinib +/- MTX
Anti-IL-6:
- Sarilumab + MTX
- Toclilizumab + MTX
Anti-B Cell

Question 8

What should you do if everything is undercontrol for over a year without CC?

Answer 8

Consider cautiously reducing dose / stopping DMARD therapy.
Return to prevois DMARD regim is target is no longer met.

Question 9

Symptom control of RA?

Answer 9

Consider NSAIDs when controlling pain & stiffness.
Use of lowest effective dose for short time.
Offer PPI

Question 10

What is the flare management in RA?

Answer 10

Pt with recent onset or established RA - Short term Glucocorticoid - can rapidly reduce inflammation.