Image of Liana Fraenkel, M.D., MPH

The American College of Rheumatology has previewed its 2020 Guideline for the Management of Rheumatoid Arthritis, with new recommendations that encourage a step back from steroid use and a move toward biologic and synthetic therapies.

The guidance emphasizes starting patients early on the immunosuppressive methotrexate and keeping them on the drug instead of switching to other anti-rheumatics, said Liana Fraenkel, M.D., of Yale University School of Medicine.

“We offer rheumatologists guidance on the nuances of how to really maximize the use of methotrexate in these patients,” she said Monday at the ACR’s annual meeting.

New additions to the guidelines include:

  • A recommendation to minimize the use of glucocorticoids, or steroids, to treat rheumatoid arthritis inflammation, due to the serious side effects associated with these drugs.
  • A recommendation to add a biologic or a targeted synthetic disease-modifying anti-rheumatic drugs instead of switching patients to triple therapy.
  • Advice on drug tapering and treatment of patient populations not covered in previous guidelines.

Rheumatologists often need to individualize rheumatoid arthritis management, and drugs are being approved for the disease at a rapid pace. The 2020 guidelines update was created using substantial patient input. It was also planned as a “living document,” with new information added as it arrives, the ACR said. 

Although these recommendations focus solely on drug treatments for rheumatoid arthritis, future ACR guidelines will include non-drug therapies and vaccines, the authors noted.