Should a 38-year-old male with seropositive Rheumatoid Arthritis (RA) continue his current treatment plan with Simponi Aria (Golimumab) infusions every 8 weeks and Meloxicam (Meloxicam) 15 mg daily as needed for breakthrough pain?

Continuation of Simponi Aria and Meloxicam for Rheumatoid Arthritis

Yes, this 38-year-old male with seropositive RA should continue his current treatment regimen with Simponi Aria 2mg/kg IV every 8 weeks and Meloxicam 15 mg as needed, as he demonstrates excellent disease control with minimal disease activity (CDAI: 3, RAPID3: 0) and no significant adverse effects. 1

Disease Activity Assessment Supports Continuation

The patient has achieved low disease activity/near-remission on his current regimen:

• CDAI score of 3 indicates remission (CDAI ≤2.8) or very low disease activity 2
• RAPID3 score of 0 demonstrates minimal functional impairment 2
• Morning stiffness of only 15-30 minutes (significantly improved from typical RA presentation) 3
• Pain score of 2/10 with no nocturnal pain awakening 3
• Minimal joint involvement: Only tenderness in tarsometatarsal joints and limited deformities in left wrist/PIPs/MCP 3
• Preserved function: No difficulty with ADLs, fully able to manage household, continues regular exercise 2

FDA-Approved Indication and Dosing

Simponi Aria is FDA-approved for moderately to severely active RA in combination with methotrexate:

• The patient's dosing of 2 mg/kg IV every 8 weeks is the correct FDA-approved regimen 1
• While the patient is not currently on methotrexate, his disease is well-controlled on monotherapy 1
• The patient has documented failure of multiple prior biologics (Remicade, Inflectra, Cimzia) before achieving control with Simponi Aria 4

Rationale for Continuing Current Therapy

Discontinuing or de-escalating therapy in this patient would be premature and potentially harmful:

• The patient has not achieved sustained remission for ≥1 year, which is the threshold for considering therapy de-escalation 2
• History of multiple biologic failures indicates this is a difficult-to-treat patient who has finally achieved control 4
• Recent appointment notes indicate "overall good disease control" maintained on current regimen 2
• No evidence of serious adverse effects from Simponi Aria (patient tolerated infusions well, no infections, normal labs including renal function, liver enzymes, and CBC) 1

Meloxicam Use is Appropriate

Meloxicam 15 mg as needed for breakthrough pain is reasonable:

• Patient uses meloxicam approximately once per week, indicating minimal need for additional analgesia 3
• Meloxicam 7.5-15 mg daily is recommended for Grade 1 inflammatory arthritis (mild pain with inflammatory symptoms) 3
• The patient's infrequent use (once weekly) is well below daily dosing and represents appropriate management of minor breakthrough symptoms 5, 6
• No contraindications documented: Normal renal function supports safe NSAID use 7

Safety Monitoring is Adequate

The patient has appropriate monitoring in place:

• Recent labs (within appropriate timeframe): Renal function, liver enzymes, CBC all within normal limits 1
• TB screening current: Quantiferon TB Gold plus ordered 1
• Hepatitis B and C screening ordered as required for TNF-blocker therapy 3, 1
• Regular follow-up scheduled: Next infusion in 8 weeks with ongoing rheumatology monitoring 3

Critical Pitfall to Avoid

Discontinuing effective biologic therapy in a patient with low disease activity (but not sustained remission) risks disease flare:

• The patient achieved this control only after failing three other biologics 4
• Premature discontinuation could lead to irreversible joint damage if disease flares 3
• Guidelines recommend continuing current therapy until sustained remission (≥1 year) is documented 2
• The presence of some residual disease activity (CDAI: 3, mild morning stiffness, occasional breakthrough pain) indicates ongoing inflammatory process requiring continued suppression 3, 2

Upcoming Procedural Consideration

Wisdom tooth extraction scheduled requires coordination with infusion timing:

• Next infusion due around the time of dental procedure 1
• Consider timing adjustment to minimize infection risk peri-procedurally, though no absolute contraindication to proceeding as scheduled 1
• Ensure dental prophylaxis if indicated and monitor for post-procedural infection 1