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Treatment of rheumatoid arthritis in adults resistant to initial biologic DMARD therapy

Authors
Stanley Cohen, MD
Amy Cannella, MD, MS, RhMSUS
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. In patients with disease resistant to methotrexate (MTX) monotherapy, and whose condition is also resistant to treatment with an initial course of biologic disease-modifying antirheumatic drug (DMARD), usually a tumor necrosis (TNF) inhibitor, typically administered in combination with MTX, timely adjustments in the treatment regimen are required to achieve effective disease control and to prevent damage to the joints. The achievement and maintenance of tight control of disease by use of DMARDs is associated with improved outcomes, as these medications and strategies have the potential to control synovitis and to slow or even stop radiographic progression [1-11]. (See "General principles of management of rheumatoid arthritis in adults", section on 'Tight control'.)

The treatment of active RA in adults who are resistant to initial therapy with a biologic DMARD, usually a TNF inhibitor in the context of ongoing treatment with MTX, will be reviewed here. The general principles of the management of RA, the initial treatment of RA, the treatment of patients resistant to initial therapy with nonbiologic DMARDs (eg, MTX monotherapy), and the approach to RA patients with severe structural damage are presented separately. (See "General principles of management of rheumatoid arthritis in adults" and "Alternatives to methotrexate for the initial treatment of rheumatoid arthritis in adults" and "Initial treatment of rheumatoid arthritis in adults", section on 'Monitoring and reevaluation' and "Total joint replacement for severe rheumatoid arthritis" and "Evaluation and medical management of end-stage rheumatoid arthritis" and "Treatment of rheumatoid arthritis in adults resistant to initial nonbiologic DMARD therapy".)

GENERAL PRINCIPLES AND APPROACH

Principles of management — There are several general principles that are important in the management of all patients with rheumatoid arthritis (RA). Briefly, these include:

Achievement and maintenance of tight control of disease activity, defined as remission or a state of low disease activity, without compromising safety

Treatment of all patients diagnosed with RA with disease-modifying antirheumatic drug (DMARD) therapy

                          

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Literature review current through: Nov 2016. | This topic last updated: Fri Apr 01 00:00:00 GMT+00:00 2016.
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