DMARD regimens

Last reviewed 01/2018

Introducing and withdrawing DMARDs (1)

  • if newly diagnosed active rheumatoid arthirtis (RA)
    • offer a combination of DMARDs (including methotrexate and at least one other DMARD, plus short-term glucocorticoids) as first-line treatment as soon as possible, ideally within 3 months of the onset of persistent symptoms
  • consider offering short-term treatment with glucocorticoids (oral, intramuscular or intra-articular) to rapidly improve symptoms in people with newly diagnosed RA if they are not already receiving glucocorticoids as part of DMARD combination therapy
  • if recent-onset RA receiving combination DMARD therapy and in whom sustained and satisfactory levels of disease control have been achieved
    • cautiously try to reduce drug doses to levels that still maintain disease control
  • if newly diagnosed RA for whom combination DMARD therapy is not appropriate
    • start DMARD monotherapy, placing greater emphasis on fast escalation to a clinically effective dose rather than on the choice of DMARD
  • in people with established RA whose disease is stable, cautiously reduce dosages of disease-modifying or biological drugs. Return promptly to disease-controlling dosages at the first sign of a flare
  • when introducing new drugs to improve disease control into the treatment regimen of a person with established RA, consider decreasing or stopping their pre-existing rheumatological drugs once the disease is controlled
  • in any person with established rheumatoid arthritis in whom disease-modifying or biological drug doses are being decreased or stopped, arrangements should be in place for prompt review

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