From the Guidelines
Rheumatoid arthritis diagnosis and management involves specific laboratory tests, including rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (anti-CCP), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), and a range of treatment options, with methotrexate being the first-line disease-modifying antirheumatic drug (DMARD) 1. The diagnosis of rheumatoid arthritis typically relies on a combination of clinical examination, laboratory tests, and imaging studies.
- Laboratory tests include:
- Rheumatoid factor (RF)
- Anti-cyclic citrullinated peptide antibodies (anti-CCP)
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- Complete blood count to check for anemia
- Imaging studies include:
- X-rays to assess joint damage
- Ultrasound to detect synovitis
- MRI to evaluate joint and bone damage Treatment follows a step-up approach, starting with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) for symptom relief, and then progressing to DMARDs, with methotrexate (starting at 7.5-10mg weekly, potentially increasing to 20-25mg) being the first-line treatment 1.
- Other conventional DMARDs include:
- Hydroxychloroquine (200-400mg daily)
- Sulfasalazine (1-3g daily)
- Leflunomide (10-20mg daily)
- For inadequate response, biologic DMARDs like TNF inhibitors (adalimumab, etanercept, infliximab), IL-6 inhibitors (tocilizumab), T-cell costimulation modulators (abatacept), or JAK inhibitors (tofacitinib, baricitinib) may be added 1. Regular monitoring of disease activity, medication side effects, and joint function is essential, with laboratory tests repeated every 1-3 months initially and then every 3-6 months during stable disease, as recommended by the 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis 1. The primary target for treatment of rheumatoid arthritis should be a state of clinical remission, and treatment decisions should be reevaluated within a minimum of 3 months based on efficacy and tolerability of the DMARD(s) chosen, according to the 2021 American College of Rheumatology guideline 1. Patient education and a shared decision-making process are crucial in the management of rheumatoid arthritis, as emphasized by the 2021 American College of Rheumatology guideline 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Laboratory Tests for Rheumatoid Arthritis
- Rheumatoid factor and anti-citrullinated protein antibody tests are commonly used to diagnose rheumatoid arthritis (RA) 2, 3, 4, 5, 6
- Elevated C-reactive protein level and erythrocyte sedimentation rate are also consistent with a diagnosis of RA 2, 3, 4, 5, 6
- Complete blood count with differential and assessment of renal and hepatic function are part of the initial laboratory evaluation 4
- Patients taking biologic agents should be tested for hepatitis B, hepatitis C, and tuberculosis 4
Treatment Options for Rheumatoid Arthritis
- Methotrexate is typically the first-line agent for RA 2, 4, 5
- Disease-modifying antirheumatic drugs (DMARDs) and biologic agents are used to control the disease 2, 4, 5
- Combinations of medications are often used to achieve disease remission or the lowest disease activity possible 2, 4, 5
- Joint replacement is indicated for patients with severe joint damage whose symptoms are poorly controlled by medical management 4
Diagnosis and Management
- Early diagnosis of RA allows for earlier treatment with DMARDs, which is associated with better outcomes 2, 4, 5
- A treat-to-target approach, including rapid interventions to reduce disease activity and achieve remission, is recommended 5
- Patient quality of life has improved dramatically with biologic DMARDs and targeted synthetic DMARDs 5
- Routine vaccinations should be up to date in patients taking DMARDs, as they increase the risk of infection 5