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Rheumatoid Arthritis Treatment Guidelines Updated
Date:6/26/2008

New rules called 'extensive' but not meant to crowd physicians' clinical judgment

THURSDAY, June 26 (HealthDay News) -- New recommendations for the use of disease-modifying anti-rheumatic drugs (DMARDs) in the treatment of rheumatoid arthritis (RA) have been developed by the American College of Rheumatology.

The recommendations on the use of non-biologic and biologic DMARDs in RA address five key areas: indications for use; monitoring for side effects; assessing clinical response; screening for tuberculosis (a risk factor associated with biologic DMARDs); and under certain circumstances (i.e. high disease activity) the roles of cost and patient preference in choosing biologic agents.

The recommendations, published in the June issue of the journal Arthritis Care & Research, also take into account RA disease duration, disease severity, and prognostic features.

"These recommendations were developed for specialist clinicians familiar with assessing RA disease activity and disease severity," project co-leader Dr. Kenneth Saag, professor of medicine and epidemiology at the University of Alabama at Birmingham, said in a prepared statement.

"Applying these recommendations to clinical practice requires individualized patient assessment and clinical decision-making. The recommendations developed are not intended to be used in a 'cookbook' or prescriptive manner or to limit a physician's clinical judgment, but rather to provide guidance based on clinical evidence and expert panel input," Saag said.

The recommendations include:

  • Methotrexate or leflunomide therapy is recommended for most RA patients.
  • Methotrexate plus hydroxychloroquine is endorsed for patients with moderate to high disease activity.
  • The triple DMARD combination of methotrexate plus hydroxychloroquine plus sulfasalazine for patients with poor prognostic features and moderate to high levels
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