What are the management instructions for a patient with rheumatoid arthritis (RA) whose symptoms are controlled with meloxicam (Nonsteroidal Anti-Inflammatory Drug (NSAID))?

Management Instructions for RA Patients Controlled with Meloxicam

Patients with rheumatoid arthritis whose symptoms are controlled with meloxicam should continue the medication at the current effective dose with regular monitoring for potential side effects.

Medication Continuation and Dosing

• Meloxicam is an effective NSAID for managing RA symptoms with a favorable gastrointestinal safety profile compared to other NSAIDs 1, 2
• The standard effective dose is 7.5-15 mg once daily, which provides good symptom control while minimizing side effects 3, 4
• For patients with well-controlled symptoms, maintain the current effective dose without unnecessary dose increases 2
• Meloxicam can be continued long-term as part of the treatment strategy when effective, with studies showing maintained efficacy over 18 months 2

Monitoring Requirements

• Schedule regular follow-up visits every 3-6 months to assess disease activity and medication effectiveness 5
• Monitor for potential gastrointestinal side effects, which occur in approximately 28% of patients on long-term therapy 2
• Perform periodic laboratory tests to check renal function, as NSAIDs can affect kidney function 5
• Consider cardiovascular risk assessment, as all NSAIDs carry some cardiovascular risk 5

Perioperative Management

• If the patient requires elective surgery such as total hip or knee arthroplasty, meloxicam can be continued throughout the perioperative period 5
• Unlike biologic DMARDs, NSAIDs do not need to be withheld before surgery according to current guidelines 5
• After surgery, meloxicam can be resumed when oral medications are permitted 5

Combination Therapy Considerations

• If RA symptoms are adequately controlled with meloxicam alone, additional DMARDs may not be necessary 5
• For patients with inadequate response or disease progression despite meloxicam, consider adding conventional synthetic DMARDs such as methotrexate, which should be part of the first treatment strategy 5
• Low-dose glucocorticoids (≤10 mg prednisone equivalent/day) may be added temporarily for disease flares but should be tapered as rapidly as clinically feasible 5

Special Circumstances

• During COVID-19 infection or exposure, meloxicam may be continued unless the patient develops severe respiratory symptoms 5
• For patients with comorbid conditions like cardiovascular disease, renal impairment, or gastrointestinal disorders, closer monitoring is required 5
• If the patient achieves sustained remission, maintain the current treatment regimen rather than reducing NSAID dose to prevent disease flares 5

Patient Education

• Instruct patients to take meloxicam with food to minimize gastrointestinal irritation 2
• Advise patients to report any signs of gastrointestinal bleeding (black stools, abdominal pain) or cardiovascular symptoms (chest pain, shortness of breath) 5
• Educate patients about the importance of adherence to medication even when symptoms are controlled 5
• Inform patients that meloxicam controls symptoms but does not necessarily modify disease progression, so regular monitoring remains important 5

When to Consider Treatment Adjustments

• If disease activity increases despite meloxicam, consider adding or switching to conventional synthetic DMARDs 5
• For patients with poor prognostic factors and inadequate response to meloxicam plus conventional DMARDs, biologic DMARDs may be considered 5
• If gastrointestinal side effects develop, consider gastroprotective agents such as proton pump inhibitors rather than discontinuing meloxicam 5