From the Guidelines
Rheumatoid arthritis treatment should be initiated as soon as the diagnosis is made, with the goal of reaching sustained remission or low disease activity, and therapy with disease-modifying antirheumatic drugs (DMARDs) should be started immediately. This approach is based on the latest recommendations from the EULAR 1, which emphasize the importance of early treatment to prevent joint damage and disability. The treatment strategy should include:
- DMARDs as the cornerstone of treatment, with methotrexate being a common first-line option
- Monitoring of disease activity every 1-3 months, with adjustments to therapy if there is no improvement by 3 months or if the target has not been reached by 6 months 1
- Consideration of alternative DMARDs, such as leflunomide or sulfasalazine, in patients with contraindications to methotrexate 1
- Potential addition of biologic agents, such as TNF inhibitors, for patients who do not respond adequately to conventional DMARDs
- Use of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids for symptom management, but with caution due to potential side effects. Regular physical therapy, exercise, and joint protection techniques are also essential non-medication approaches to manage the disease.
From the FDA Drug Label
B cells are believed to play a role in the pathogenesis of rheumatoid arthritis (RA) and associated chronic synovitis. In this setting, B cells may be acting at multiple sites in the autoimmune/inflammatory process, including through production of rheumatoid factor (RF) and other autoantibodies, antigen presentation, T-cell activation, and/or proinflammatory cytokine production.
In RA patients, treatment with RITUXAN induced depletion of peripheral B lymphocytes, with the majority of patients demonstrating near complete depletion (CD19 counts below the lower limit of quantification, 20 cells/µl) within 2 weeks after receiving the first dose of RITUXAN.
Rheumatoid Arthritis Treatment: Rituximab is used to treat rheumatoid arthritis (RA) by depleting B cells, which are believed to play a role in the pathogenesis of RA.
- Key Points:
- B cells contribute to the autoimmune/inflammatory process in RA.
- Rituximab induces depletion of peripheral B lymphocytes in RA patients.
- Depletion occurs within 2 weeks of receiving the first dose of rituximab. 2
From the Research
Rheumatoid Arthritis Treatment
- Rheumatoid arthritis (RA) is a chronic inflammatory disorder that can cause pain, swelling, and stiffness in the joints 3.
- Biologic disease-modifying antirheumatic drugs (DMARDs) are increasingly used for RA treatment, but little is known about the factors associated with DMARDs and patterns of use of biologic DMARDs for initial and subsequent RA treatment 3.
- A study found that patients in commercial insurance were 87% more likely to initiate a biologic DMARD versus patients in Medicaid, and African-Americans had lower odds of initiating and switching biologic DMARDs than non-Hispanic whites 3.
Treatment Options
- Triple therapy (methotrexate, sulfasalazine, and hydroxychloroquine) was found to be more durable than methotrexate-etanercept in RA patients with suboptimal methotrexate response 4.
- Etanercept was effective as monotherapy or in combination with methotrexate in RA, with ETN + MTX appearing marginally more effective than ETN monotherapy in some outcomes 5.
- Patients consider several factors when deciding about disease-modifying antirheumatic drugs, including beliefs in the necessity of DMARDs, trust in the rheumatologist and healthcare system, and concerns about side effects and long-term medication use 6.
Disease Progression
- Aggressive initial treatment of early RA with a combination of 3 DMARDs for the first 2 years can limit peripheral joint damage for at least 5 years 7.
- A study found that the median Larsen radiologic damage scores at baseline, 2 years, and 5 years in the combination-DMARD and single-DMARD groups were significantly different, indicating a slower progression of joint damage in the combination-DMARD group 7.
- Remission rates were also higher in the combination-DMARD group at 2 years, but not at 5 years, suggesting that early aggressive treatment can lead to better outcomes in the long term 7.