Guideline: Treatment of Rheumatoid Arthritis
Rheumatoid arthritis (RA) is the most common autoimmune inflammatory arthritis in adults (1). RA has a significant negative impact on the ability to perform daily activities, including work and household tasks, and healthrelated quality of life, and it increases mortality (2–4). The American College of Rheumatology (ACR) last published a guideline for RA management in 2012 (5), which was an update of the 2008 RA guideline (6).Because there has been rapid accrual of evidence and new therapies, advancement of guideline development methodologies,
and the need to broaden the scope of its 2012 RA recommendations,the ACR has developed a new 2015 RA
pharmacologic treatment guideline.
This guideline addresses 6 major topics:
1) use of traditional disease-modifying antirheumatic drugs (traditional/conventional DMARDs, herein referred to as DMARDs), biologic DMARDs (herein referred to as biologics), and tofacitinib, including tapering and discontinuing medications, and a treat-to-target approach;
2) use of glucocorticoids;
3) use of biologics and DMARDs in high-risk populations (i.e., those with hepatitis, congestive heart failure,malignancy, and serious infections);
4) use of vaccines in patients starting/receiving DMARDs or biologics;
5) screening for tuberculosis (TB) in the context of biologics or tofacitinib;
6) laboratory monitoring for traditional DMARDs.