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Initial treatment of rheumatoid arthritis in adults

Authors
Stanley Cohen, MD
Ted R Mikuls, MD, MSPH
Section Editor
James R O'Dell, MD
Deputy Editor
Paul L Romain, MD

INTRODUCTION

The treatment of rheumatoid arthritis (RA) is directed toward the control of synovitis and the prevention of joint injury. Support for an early aggressive approach to treatment is based upon the observations that joint damage, which may ultimately result in disability, begins early in the course of disease and that the longer active disease persists, the less likely the patient is to respond to therapy [1]. Improved outcomes have resulted from the use of potent and well-tolerated nonbiologic (traditional) and biologic disease-modifying antirheumatic drugs (DMARDs) used alone and in combination to induce and maintain tight control of disease [2-10]. These medications and strategies have the potential to control synovitis and slow or stop radiographic progression [2,9,11,12].

These observations regarding the course of disease and the efficacy of these therapeutic approaches, coupled with limits in the ability to accurately identify individuals with a poor prognosis, support our view that every patient with established active RA should be treated with DMARDs at the earliest stage of disease, ideally within three months of symptom onset. (See "General principles of management of rheumatoid arthritis in adults".)

The treatment of patients with active RA, with methotrexate (MTX) as initial DMARD monotherapy and regardless of duration, will be reviewed here. The diagnosis and differential diagnosis, the general principles of management, and an overview of the therapy of RA, the initial treatment of RA using DMARD therapy other than MTX, and the treatment of disease resistant to initial therapy are presented separately. (See "Diagnosis and differential diagnosis of rheumatoid arthritis" and "General principles of management of rheumatoid arthritis in adults" and "Alternatives to methotrexate for the initial treatment of rheumatoid arthritis in adults" and "Treatment of rheumatoid arthritis in adults resistant to initial nonbiologic DMARD therapy" and "Treatment of rheumatoid arthritis in adults resistant to initial biologic DMARD therapy".)

GENERAL PRINCIPLES

There are several general principles important in the management of all patients with rheumatoid arthritis (RA). These principles are discussed in detail elsewhere. (See "General principles of management of rheumatoid arthritis in adults".)

Briefly, these include:

                             

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Literature review current through: Nov 2016. | This topic last updated: Mon Jul 11 00:00:00 GMT+00:00 2016.
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