Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterized by inflammatory arthritis and extra-articular involvement. The management of RA has seen significant updates in recent years, particularly with the release of various guidelines from respected bodies such as the American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatology (EULAR).
The 2022 ACR guidelines emphasize the importance of exercise, diet, and integrative interventions in the management of RA. This includes a specific guideline for exercise rehabilitation, underscoring its critical role in patient care. The full manuscript of these recommendations, approved by the ACR Board of Directors, was published in Arthritis & Rheumatology and Arthritis Care and Research. The updated guidelines highlight the use of disease-modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs. Additionally, they address the use of glucocorticoids and the management of RA in high-risk populations, such as those with liver disease or heart failure.
A significant aspect of these guidelines is the treat-to-target approach, which, despite limited evidence, is strongly recommended for patients not previously treated with biologics or small molecule drugs. In this approach, doctors and patients collaborate to set a goal and adjust treatment to achieve it.
In the EULAR 2022 update, there is a focus on the management of RA with synthetic and biological DMARDs. This update, detailed in the Annals of the Rheumatic Diseases, presents a comprehensive view of the current strategies in RA treatment, especially in the context of these medications.
For patients who do not achieve adequate symptom control with methotrexate alone, the guidelines recommend considering triple therapy or the addition of another medication. This strategy is supported by various studies demonstrating the effectiveness of combination therapies in RA management.
For more detailed information, readers can refer to the original guidelines and studies. Links to some of these key resources are provided below:
2022 American College of Rheumatology Guideline for Exercise
EULAR recommendations for the management of rheumatoid arthritis
Rheumatoid Arthritis Treatment Guidelines
Rheumatoid Arthritis – Arthritis Foundation
Rheumatoid Arthritis – StatPearls – NCBI Bookshelf
2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis
2022 Integrative Interventions for Rheumatoid Arthritis
ACR Journals – Rheumatology and Arthritis Care and Research
