Pillole.org – Pills: Rheumatoid Arthritis: A Review

In the first part devoted to Rheumatoid arthritis, some general aspects of diagnosis and therapy were synthesized

. The main recommendations of the EULAR directives will be recalled
Of course, we will limit ourselves to the general principles likely to interest the general practitioner because the complexity of the care always requires specialized advice both in the initial setting of the treatment that in the evaluation of possible therapeutic variations

In general, the choice of treatment should be based on disease, on the severity of joint damage, on the tolerability of drugs, on the presence of comorbidity in the patient individual. In any case, as mentioned in the first part, therapy with DMARD should be started as soon as possible

Monitoring of the efficacy of treatment should be performed every 1-3 month. If no improvement is obtained within 3 months of treatment or if the desired target is not reached within 6 months, treatment should be re-evaluated for possible variation.

methotrexate should be part of the treatment. initial treatment. If methotrexate is contraindicated or not tolerated, leflunomide or sulfasalazine should be considered an alternative.

Steroids must be badociated with a csDMARD when you start therapy or when you change a csDMARD. However, steroid treatment should be rapidly reduced and discontinued as soon as it is clinically feasible.

In case of failure of the first csDMARD used in the absence of adverse prognostic signs, one should switch or badociate another csDMARD ; if, on the other hand, there are adverse prognostic signs, a bDMARD or tsDMARD should be badociated.

In case of subsequent failure, any other bDMARD or tsDMARD are recommended alternatives

. in persistent remission, after reduction and discontinuation of the steroid, consideration should be given to reducing the doses of DMARDs used

Renato Rossi

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