What are the treatment options for Rheumatoid Arthritis (RA) flare?

From the Guidelines

For a rheumatoid arthritis (RA) flare, I recommend a multi-faceted approach combining rest, medication adjustments, and self-care strategies, prioritizing the most recent guidelines from the American College of Rheumatology 1. The treatment approach should be based on a shared decision-making process between the patient and the rheumatologist, taking into account the patient's disease activity, medical history, and potential contraindications to certain medications. Some key considerations for managing an RA flare include:

• Starting with a short-term increase in anti-inflammatory medications like NSAIDs (ibuprofen 400-800mg three times daily or naproxen 500mg twice daily) for 3-7 days, as recommended by the European League against Rheumatism 1
• If already on corticosteroids, a temporary prednisone dose increase (typically 5-10mg daily for 3-7 days) may help control inflammation quickly
• Applying ice to affected joints for 15-20 minutes several times daily to reduce swelling and pain
• Resting the inflamed joints while maintaining gentle movement to prevent stiffness
• Contacting the rheumatologist promptly as the long-term RA medications may need adjustment, which could include increasing the current DMARD dose, adding a short course of corticosteroids, or changing the treatment regimen, as suggested by the American College of Rheumatology 1
• Protecting the joints during flares by using assistive devices and avoiding activities that worsen symptoms These interventions work by reducing inflammatory cytokines and immune system overactivity that cause joint damage during flares. Adequate hydration, balanced nutrition, and stress management techniques can also support recovery from an RA flare. It is essential to follow the most recent guidelines and consult with a rheumatologist to determine the best course of treatment for each individual patient, considering the latest recommendations from the American College of Rheumatology 1.

From the FDA Drug Label

1.1 Rheumatoid Arthritis HUMIRA is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis. HUMIRA can be used alone or in combination with methotrexate or other non-biologic disease-modifying anti-rheumatic drugs (DMARDs).

The treatment for RA flare is HUMIRA, which can be used alone or in combination with methotrexate or other non-biologic DMARDs. The recommended dosage of HUMIRA for adult patients with RA is 40 mg administered every other week. In some cases, the dosage may be increased to 40 mg every week or 80 mg every other week for patients not taking concomitant methotrexate 2.

From the Research

Treatment Options for RA Flare

• The treatment for RA flare includes oral conventional synthetic disease-modifying antirheumatic drugs (DMARDs), injectable biologic DMARDs, and targeted synthetic DMARDs (oral) 3.
• Key recommendations are to start effective treatment immediately with DMARDs to reduce disability, use effective doses of methotrexate with folic acid as the initial treatment, and rapidly escalate treatment with various DMARDs if methotrexate alone is not effective in controlling rheumatoid arthritis 3.
• Low dose short-term prednisone therapy can be effective in inducing remission in newly diagnosed RA patients, with 54.2% of patients reaching remission and 69.7% showing a good response to treatment 4.

DMARDs and Biologics

• Most novel DMARDs have similar levels of efficacy in combination with methotrexate (MTX) in patients with inadequate response to conventional DMARDs 5.
• Tocilizumab as monotherapy displayed higher ACR responses than anti-tumor necrosis factor agents (aTNF) or tofacitinib, and ACR responses with tocilizumab plus MTX were similar to those with tocilizumab as monotherapy 5.
• Methotrexate is often used as the anchor drug in treatment, with 89.2% of patients taking MTX, and 60% taking MTX as a single DMARD or in combination with traditional DMARD 6.

Flare Management

• Patients with RA experienced flares more often when in higher disease activity states than when in remission, and reported changes in disease-modifying antirheumatic drugs or biologics more frequently when flares were of longer duration 7.
• Longer duration of flare was associated with changes in disease-modifying therapy, and 40% of patients reported medication changes at the time of their flare 7.