From the Guidelines
Oral medications used to control flare-ups in patients with Rheumatoid Arthritis (RA) include conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) such as methotrexate, and targeted synthetic DMARDs (tsDMARDs) like Janus kinase (JAK) inhibitors, including tofacitinib and baricitinib.
Key Medications
- Methotrexate: should be started at 10–15 mg/week, with escalation of 5 mg every 2–4 weeks up to 20–30 mg/week, depending on clinical response and tolerability 1
- JAK inhibitors: such as tofacitinib and baricitinib, are used as oral medications to control flare-ups in patients with RA 1
Treatment Considerations
- The choice of medication depends on the patient's characteristics, such as comorbidities, and the perceived differences in safety across drugs 1
- Treatment strategies, such as treat-to-target, aim to achieve sustained clinical remission or low disease activity 1
- The use of biologic and small oral molecules therapies, including JAK inhibitors, has changed the scenario of pharmacologic treatment of systemic rheumatic diseases, offering new options for patients with RA 1
From the Research
Oral Medications for Rheumatoid Arthritis Flare-ups
- Methotrexate is typically the first-line drug for rheumatoid arthritis, and it is often used to control the disease 2, 3.
- Biologic agents, such as tumor necrosis factor inhibitors, are generally considered second-line agents or can be added for dual therapy to control flare-ups 2.
- Oral glucocorticoids, such as prednisolone, can be used to control flare-ups, but their use should be tapered or discontinued when possible to minimize side effects 4.
- Disease-modifying antirheumatic drugs (DMARDs) and targeted synthetic DMARDs can be used to reduce disease activity and achieve remission, and they may be adjusted or changed in response to flare-ups 3, 5.
Management of Flare-ups
- Flare-ups are common in patients with rheumatoid arthritis, and they can be managed with medication changes, nonpharmacologic strategies, or a combination of both 5.
- The duration of flare-ups can vary, but longer duration is associated with changes in disease-modifying therapy 5.
- Patients with higher disease activity states are more likely to experience flare-ups, and they may require more frequent changes to their treatment plan 5.