ACR RA guidelines ‘push the needle away’ from glucocorticoids as primary option

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Sumary of ACR RA guidelines ‘push the needle away’ from glucocorticoids as primary option:

  • Bryant England, MD, PhD, of the University of Nebraska Medical Center, provided an overview of the guideline development process..
  • With the teams in place, the next step was to develop Population- Intervention- Comparator- Outcomes questions..
  • Zeroing in on the points with the highest level of evidence, methotrexate is strongly recommended over hydroxychloroquine or sulfasalazine, and strongly recommended over biologic or targeted synthetic DMARD monotherapy..
  • In looking at DMARD monotherapy compared with combination approaches, methotrexate monotherapy, again, is strongly recommended over hydroxychloroquine or sulfasalazine..
  • Methotrexate monotherapy is also strongly preferred compared with methotrexate plus a non-TNF inhibitor biologic or a traditional synthetic DMARD..
  • Regarding the mitigation of glucocorticoids, DMARDS without longer-term glucocorticoid therapy — defined by a 3-month boundary — is strongly recommended over DMARDs plus longer-term steroids….

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