rheumatoid%20arthritis
RHEUMATOID ARTHRITIS
Treatment Guideline Chart

Rheumatoid arthritis is a systemic autoimmune rheumatic disorder of unknown etiology.
It is the most common form of inflammatory arthritis.
Patient usually complains of joint pain and/or swelling with morning stiffness that lasts for more than an hour.

Goals of treatment are clinical and radiological remission of disease and to reduce functional limitations and permanent joint damage.

Rheumatoid Arthritis References

  1. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/ European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010 Sep;69(9):1580-1588. doi: 10.1136/ard.2010.138461. PMID: 20699241
  2. Furst DE, Breedveld FC, Kalden JR, et al. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2007. Ann Rheum Dis. 2007 Nov;66(Suppl 3):iii2-iii22. PMID: 17934088
  3. Majithia V, Geraci SA. Rheumatoid arthritis: diagnosis and management. Am J Med. 2007 Nov;120(11):936-939. PMID: 17976416
  4. Felson DT, Smolen JS, Wells G, et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum. 2011 Mar;63(3):573-586. doi: 10.1002/art.30129. PMID: 21294106
  5. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008 Jun;59(6):762-784. doi: 10.1002/art.23721. PMID: 18512708
  6. Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis. 2010 Jun;69(6):964-975. doi: 10.1136/ard.2009.126532. PMID: 20444750
  7. Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012 May;64(5):625-639. doi: 10.1002/acr.21641. PMID: 22473917
  8. National Institute for Health and Care Excellence. Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a tumour necrosis factor inhibitor. NICE website. http://www.nice.org.uk/guidance/ta195/resources/guidance-adalimumab-etanercept-infliximab-rituximab-and-abatacept-for-the-treatment-of-rheumatoid-arthritis-after-the-failure-of-a-tnf-inhibitor-pdf. Aug 2010.
  9. National Institute for Health and Care Excellence. Adalimumab, etanercept, and infliximab for the treatment of rheumatoid arthritis. NICE website. http://www.nice.org.uk/guidance/ta130/resources/guidance-adalimumab-etanercept-and-infliximab-for-the-treatment-of-rheumatoid-arthritis-pdf. Sep 2010.
  10. National Institute for Health and Care Excellence. Abatacept for treating rheumatoid arthritis after the failure of conventional disease-modifying anti-rheumatic drugs (rapid review of technology appraisal guidance 234). NICE website. http://www.nice.org.uk/nicemedia/live/14155/63676/63676.pdf. Apr 2013. Accessed 04 Jul 2013.
  11. Venables PJW, Maini RN. Clinical features of rheumatoid arthritis. UptoDate Web Site. http://www.uptodate.com/index. Feb 2011. Accessed 15 Apr 2011.
  12. National Institute for Health and Care Excellence. Certolizumab pegol for the treatment of rheumatoid arthritis. NICE website. http://www.nice.org.uk/guidance/ta186/resources/guidance-certolizumab-pegol-for-the-treatment-of-rheumatoid-arthritis-pdf. Feb 2010.
  13. UCB Pharma Inc. Certolizumab pegol: Highlights of prescribing information. http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/125160s0142lbl.pdf. 2008. Accessed 05 Jul 2013.
  14. Schur PH, Maini RN, Moreland LW. General principles of management of rheumatoid arthritis. UptoDate Web Site. http://www.uptodate.com/index. Feb 2011. Accessed 16 Apr 2011.
  15. Scottish Intercollegiate Guidelines Network. Management of early rheumatoid arthritis. SIGN. http://www.sign.ac.uk. Feb 2011. Accessed 15 Apr 2011
  16. Venables PJW, Maini RN. Diagnosis and differential diagnosis of rheumatoid arthritis. UptoDate Web Site. http://www.uptodate.com/index. Nov 2010. Accessed 15 Apr 2011.
  17. National Institute for Health and Care Excellence. Rheumatoid arthritis: the management of rheumatoid arthritis in adults. NICE website. http://www.nice.org.uk/guidance/cg79/resources/guidance-rheumatoid-arthritis-pdf. Feb 2009.
  18. Schur PH, Maini RN, Gibofsky A. Nonpharmacologic and preventive therapies of rheumatoid arthritis. UptoDate Web Site. http://www.uptodate.com/index. Dec 2010. Accessed 15 Apr 2011.
  19. National Institute for Health and Care Excellence. Tocilizumab for the treatment of rheumatoid arthritis. NICE website. http://www.nice.org.uk/guidance/ta198/resources/guidance-tocilizumab-for-the-treatment-of-rheumatoid-arthritis-pdf. Aug 2010.
  20. Smolen JS, Landewé R, Breedveld FC, Buch M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014 Mar;73(3):492-509. doi: 10.1136/annrheumdis-2013-204573. PMID: 24161836
  21. Smolen JS, Breedveld FC, Burmester GR, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2015 May. http://ard.bmj.com/content/early/2015/05/12/annrheumdis-2015-207524.full.pdf. PMID: 25969430
  22. Ritter J, Lewis L, Timothy M, Alberto F. Anti-inflammatory drugs and the treatment of arthritis. In: Hodder A. A Textbook in Clinical Pharmacology and Therapeutics. 5th ed. London, UK: Hodder Education; 2008:170.
  23. Singh JA, Saag KG, Bridges SL Jr, et al; American College of Rheumatology. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2016 Jan;68(1):1-25. doi: 10.1002/acr.22783. PMID: 26545825
  24. McInnes IB. Cytokine networks in rheumatic diseases: Implications for therapy. UptoDate. http://www.uptodate.com. Aug 2018.
  25. Moreland LW, Cannella A. General principles of management of rheumatoid arthritis in adults. UptoDate. http://www.uptodate.com. May 2018.
  26. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016 Oct;388(10055):2023-2038. doi: 10.1016/S0140-6736(16)30173-8. PMID: 27156434
  27. Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017 Jun;76(6):960-977. doi: 10.1136/annrheumdis-2016-210715. PMID: 28264816
  28. England BR, Tiong BK, Bergman MJ, et al. 2019 Update of the American College of Rheumatology recommended rheumatoid arthritis disease activity measures. Arthritis Care Res (Hoboken). 2019 Dec;71(12):1540-1555. doi: 10.1002/acr.24042. PMID: 31709779
  29. Ministry of Health Malaysia, Malaysian Society of Rheumatology, Academy of Medicine Malaysia. Clinical practice guidelines. Management of rheumatoid arthritis. http://www.acadmed.org.my. 2019.
  30. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020 Jan 22. pii: annrheumdis-2019-216655. doi: 10.1136/annrheumdis-2019-216655. PMID: 31969328
  31. U.S. Food & Drug Administration (US FDA). Biosimilar product information. US FDA. https://www.fda.gov. 24 Feb 2020. Accessed 28 Feb 2020.
  32. New long-term data from Rinvoq (Upadacitinib, 15 mg) phase 3 studies in rheumatoid arthritis presented at 2020 Annual European E-Congress of Rheumatology (EULAR). Abbvie News Center. https://news.abbvie.com/. 04 Jun 2020.
  33. Taylor PC, Keystone EC, van der Heijde D, et al. Baricitinib versus placebo or Adalimumab in rheumatoid arthritis. N Engl J Med. 2017 Feb 16;376(7):652-662. doi: 10.1056/NEJMoa1608345. PMID: 28199814
  34. Furer V, Rondaan C, Heijstek MW, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020 Jan;79(1):39-52. doi: 10.1136/annrheumdis-2019-215882. PMID: 31413005
  35. Cheung TT, McInnes IB. Future therapeutic targets in rheumatoid arthritis? Semin Immunopathol. 2017 Jun;39(4):487-500. doi: 10.1007/s00281-017-0623-3. PMID: 28451787
  36. Fleischmann R, Mysler E, Hall S, et al. Efficacy and safety of tofacitinib monotherapy, tofacitinib with methotrexate, and adalimumab with methotrexate in patients with rheumatoid arthritis (ORAL Strategy): a phase 3b/4, double-blind, head-to-head, randomised controlled trial. Lancet. 2017 Jul;390(10093):457-468. doi: 10.1016/S0140-6736(17)31618-5. PMID: 28629665
  37. Fleischmann R, Pangan AL, Song IH, et al. Upadacitinib versus placebo or adalimumab in patients with rheumatoid arthritis and an inadequate response to methotrexate: Results of a phase III, double-blind, randomized controlled trial. Arthritis Rheumatol. 2019 Nov;71(11):1788-1800. doi: 10.1002/art.41032. PMID: 31287230
  38. Strand V, Lee EB, Fleischmann R, et al. Tofacitinib versus methotrexate in rheumatoid arthritis: patient-reported outcomes from the randomised phase III ORAL Start trial. RMD Open. 2016 Sep;2(2):e000308. doi: 10.1136/rmdopen-2016-000308. PMID: 27752357
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