{
"schemaVersion": 2,
"eyebrow": "Rheumatology",
"title": "Rheumatoid Arthritis",
"summary": "Rheumatoid arthritis management depends on prompt initiation of a conventional DMARD, predefined assessment against remission or low disease activity, and rapid treatment adjustment when the target is missed. Therapy selection must balance inflammatory control with methotrexate tolerance, prior DMARD response, infection risk, and cardiovascular risk factors.",
"seoDescription": "Point-of-care rheumatoid arthritis management: treat-to-target strategy, DMARD selection, escalation after inadequate response, and JAK inhibitor safety.",
"clinicalQuestion": "How should clinicians implement treat-to-target DMARD therapy and select escalation treatment for active rheumatoid arthritis?",
"specialty": "Rheumatology",
"audience": "U.S. physicians and medical trainees",
"tags": [
"rheumatoid arthritis",
"treat to target",
"methotrexate",
"DMARDs",
"biologic DMARDs",
"JAK inhibitors"
],
"keyTakeaways": [
"Start effective DMARD therapy early and use a treat-to-target strategy aimed at sustained remission or, when necessary, low disease activity; adapt therapy rapidly when the target is not reached.[10][12]",
"Treat-to-target requires a defined disease-activity target, a prespecified reassessment time point, a commitment to change therapy if the target is not achieved, and shared decision-making.[10]",
"For methotrexate contraindication, leflunomide or sulfasalazine are first-strategy alternatives.[17]",
"After inadequate methotrexate response, combination conventional DMARD therapy and biologic-based strategies are evidence-supported escalation approaches; the choice should account for adverse effects and patient-specific risks.[1][16][24]",
"Before selecting a JAK inhibitor, explicitly assess prior major adverse cardiovascular events and cardiovascular risk factors, particularly smoking, hypertension, hypercholesterolemia, and diabetes.[7]",
"JAK inhibitors have infection rates broadly similar to biologic DMARDs but higher herpes zoster rates; safety concerns regarding cardiovascular and malignancy events materially affect selection in higher-risk patients.[5][8]"
],
"sections": [
{
"id": "treat-to-target",
"eyebrow": "Treatment strategy",
"heading": "Use a measured treat-to-target plan from the first DMARD decision",
"intro": "Make disease activity and the next treatment decision visible at every assessment.",
"paragraphs": [
"Set sustained remission as the preferred target; use low disease activity when remission is not realistically attainable. Early referral, early diagnosis, and early initiation of effective therapy followed by rapid adaptation when the target is missed are central to limiting progression of joint damage and preserving function.[12]",
"Document the disease-activity measure used, the target, and the reassessment date before starting or changing therapy. A complete treat-to-target approach includes selecting a target and method to measure it, assessing at a prespecified time point, changing therapy if the target is not achieved, and shared decision-making; this strategy produces superior outcomes versus standard care.[10]",
"At each follow-up, distinguish active inflammatory disease from a noninflammatory source of pain or functional limitation before escalating immunomodulation. When measurable disease activity remains above the agreed target, change the DMARD strategy rather than continuing an ineffective regimen without a defined endpoint.[10][12]"
],
"bullets": [
"Record the chosen target at treatment initiation: remission when feasible, otherwise low disease activity.[10][12]",
"Schedule an objective reassessment at a prespecified interval and make a treatment change if the target is not met.[10]",
"Use shared decision-making when selecting the next mechanism, weighing efficacy, prior response, comorbidity, and safety tradeoffs.[10][7]"
],
"subsections": [],
"table": {
"caption": "Operational elements of a rheumatoid arthritis treat-to-target visit.[10][12]",
"columns": [
"Visit task",
"Decision consequence"
],
"rows": [
[
"Define remission or low disease activity as the individualized target.[10][12]",
"Provides the threshold for judging whether the current regimen should continue or change.[10]"
],
[
"Use a consistent disease-activity assessment method and specify the reassessment date.[10]",
"Allows an objective comparison with the agreed target at follow-up.[10]"
],
[
"If the target is not achieved at the planned assessment, modify therapy.[10][12]",
"Avoids prolonged exposure to insufficient disease control and supports prevention of joint damage and functional loss.[12]"
],
[
"Reassess preferences, adverse effects, and comorbidity before escalation.[10][7]",
"Selects an option with an acceptable patient-specific benefit-risk profile.[7][10]"
]
]
}
},
{
"id": "initial-dmard-strategy",
"eyebrow": "Initial therapy",
"heading": "Select the initial conventional DMARD strategy and define the escape plan",
"intro": "Use conventional DMARD therapy as the platform, then escalate according to response and tolerability.",
"paragraphs": [
"Methotrexate is the principal conventional DMARD anchor in contemporary rheumatoid arthritis treatment strategies. Conventional DMARD options considered in ACR treatment recommendations include methotrexate, hydroxychloroquine, leflunomide, sulfasalazine, and, less commonly, minocycline; combination regimens using two or three conventional DMARDs are also recognized treatment approaches.[16]",
"When methotrexate cannot be used, select leflunomide or sulfasalazine as part of the first treatment strategy rather than delaying DMARD treatment.[17] If methotrexate is used, actively elicit gastrointestinal intolerance and monitor for liver dysfunction, pneumonitis, and bone marrow toxicity, which are recognized adverse effects that can require regimen modification.[22]",
"For persistent active disease despite an adequate methotrexate-based strategy, choose between combination conventional DMARD therapy and an advanced DMARD approach based on disease activity, prior exposure, contraindications, and preference. In a randomized trial of active RA after methotrexate failure, triple conventional therapy and etanercept plus methotrexate were compared; sulfasalazine could be reduced to 500 mg twice daily for unacceptable adverse effects, illustrating a tolerability-based adjustment within combination treatment.[1]"
],
"bullets": [
"Methotrexate intolerance or contraindication: use leflunomide or sulfasalazine in the first treatment strategy.[17]",
"Methotrexate adverse-effect review: ask about gastrointestinal symptoms and evaluate for hepatic, pulmonary, and hematologic toxicity when clinically indicated.[22]",
"Inadequate response: do not leave the patient on an unchanged regimen; move to a planned combination conventional DMARD or advanced DMARD strategy.[1][10]"
],
"subsections": [
{
"heading": "Escalation choices after methotrexate inadequate response",
"paragraphs": [
"A biologic-based strategy can reduce synovitis, limit erosive damage, decrease disability, and improve quality of life in RA.[24] Available biologic classes addressed in ACR recommendations include TNF inhibitors and non-TNF biologics such as abatacept, rituximab, and tocilizumab; selection should be individualized rather than based on class labels alone.[16]",
"Conventional combination therapy remains a practical alternative when biologic access, route, cost, prior adverse events, or patient preference favor it. In the trial comparing escalation approaches after methotrexate failure, sulfasalazine dose reduction to 500 mg twice daily was permitted for unacceptable adverse effects.[1]"
],
"bullets": [
"TNF inhibitors listed in ACR recommendations include adalimumab, etanercept, infliximab, certolizumab pegol, and golimumab.[16]",
"Non-TNF biologics listed in ACR recommendations include abatacept, rituximab, and tocilizumab.[16]",
"For patients with active RA after methotrexate failure, discuss conventional triple therapy and biologic-plus-methotrexate approaches as distinct escalation pathways.[1][16]"
]
}
],
"table": {
"caption": "DMARD strategy decisions supported by rheumatoid arthritis treatment literature.[1][16][17][22][24]",
"columns": [
"Clinical branch",
"Next treatment decision",
"Key implementation issue"
],
"rows": [
[
"Initial RA requiring DMARD therapy",
"Use a conventional DMARD strategy centered on methotrexate when feasible.[16]",
"Assess tolerability and toxicity, including gastrointestinal symptoms, liver dysfunction, pneumonitis, and bone marrow toxicity.[22]"
],
[
"Methotrexate contraindicated",
"Use leflunomide or sulfasalazine as part of the first treatment strategy.[17]",
"Continue objective treat-to-target assessment rather than accepting persistent activity.[10]"
],
[
"Active RA after methotrexate inadequate response",
"Choose combination conventional DMARD therapy or a biologic-based strategy.[1][16]",
"For sulfasalazine intolerance in a triple-therapy regimen, reduction to 500 mg twice daily was permitted in a randomized trial.[1]"
],
[
"Considering biologic escalation",
"Select a TNF inhibitor or non-TNF biologic according to patient-specific factors.[16]",
"Biologic-based therapy can reduce inflammation, erosive damage, disability, and impaired quality of life.[24]"
]
]
}
},
{
"id": "jak-inhibitor-selection",
"eyebrow": "Safety-sensitive escalation",
"heading": "Risk-stratify before choosing a JAK inhibitor",
"intro": "JAK inhibitor selection requires a more explicit cardiovascular, malignancy, and infection discussion.",
"paragraphs": [
"Before prescribing a JAK inhibitor, document prior major adverse cardiovascular events and major cardiovascular risk factors, including current cigarette smoking, hypertension, hypercholesterolemia, diabetes mellitus, family history of premature coronary disease, and established coronary artery disease. ORAL Surveillance enrolled methotrexate-inadequate responders aged 50 years or older with at least one additional cardiovascular risk factor, making this phenotype particularly important when translating the safety signal to practice.[7]",
"In rheumatoid arthritis and other immune-mediated inflammatory diseases, JAK inhibitors are associated with serious infection rates similar to biologic DMARDs but with increased herpes zoster rates compared with biologic DMARDs. Reducing or eliminating concomitant glucocorticoid exposure can lower infectious-event risk.[5]",
"Do not treat JAK inhibitors as interchangeable with other advanced DMARDs in patients with elevated baseline cardiovascular or malignancy risk. Regulatory cautions were prompted by increased cardiovascular and malignancy events with tofacitinib in older RA patients with cardiovascular risk factors; when a JAK inhibitor remains the preferred option, mitigate modifiable cardiovascular risk and reassess the risk-benefit balance at each treatment change.[7][8]"
],
"bullets": [
"High-risk phenotype requiring explicit discussion: age 50 years or older plus at least one cardiovascular risk factor, as in ORAL Surveillance.[7]",
"Infection counseling: include herpes zoster risk and minimize concomitant glucocorticoid exposure when feasible.[5][8]",
"Laboratory safety concerns reported with JAK inhibition include lymphopenia, thrombocytopenia, neutropenia, and anemia.[5]",
"Thromboembolic risk is a relevant consideration: increased venous thromboembolism was reported with tofacitinib 10 mg twice daily in an RA safety trial and during the placebo-controlled period of a baricitinib RA trial.[5]"
],
"subsections": [],
"table": {
"caption": "Pre-JAK inhibitor risk review in inflammatory arthritis.[5][7][8]",
"columns": [
"Risk domain",
"What to identify",
"How it changes selection or monitoring"
],
"rows": [
[
"Cardiovascular risk",
"Prior major adverse cardiovascular events; smoking, hypertension, hypercholesterolemia, diabetes, family history of premature coronary disease, or coronary artery disease.[7]",
"Use a patient-specific risk-benefit discussion; regulatory caution is especially relevant in older RA patients with cardiovascular risk factors.[7][8]"
],
[
"Infection",
"History and current exposure that increase infection risk; concomitant glucocorticoid use.[5]",
"Discuss serious infection and increased herpes zoster risk; reduce or eliminate glucocorticoids when feasible.[5][8]"
],
[
"Hematologic toxicity",
"Lymphopenia, thrombocytopenia, neutropenia, or anemia.[5]",
"Use blood-count surveillance appropriate to the selected JAK inhibitor and clinical context.[5]"
],
[
"Thromboembolic risk",
"Factors that increase concern for venous thromboembolism.[5]",
"Consider alternatives when the anticipated benefit does not justify thromboembolic risk; avoid extrapolating safety across doses or agents without individualized review.[5]"
]
]
}
},
{
"id": "monitoring-and-adjustment",
"eyebrow": "Follow-up",
"heading": "Make monitoring trigger a treatment decision",
"intro": "Follow-up should determine whether to continue, optimize, switch, or de-escalate therapy.",
"paragraphs": [
"At every planned assessment, record disease activity relative to the predefined target, treatment adherence, toxicities, and new comorbidities that alter advanced-DMARD safety. Continue the regimen only when disease control and tolerability support the original treatment goal; otherwise optimize or switch therapy according to the escape plan established at treatment initiation.[10][12]",
"For methotrexate-based treatment, investigate new gastrointestinal symptoms and clinically suspected liver, pulmonary, or bone marrow toxicity rather than attributing symptoms automatically to RA activity.[22] For JAK inhibitors, review infectious events, herpes zoster, cytopenias, thromboembolic events, and evolving cardiovascular risk before refilling or escalating therapy.[5][7][8]",
"Patients who have failed multiple biologic DMARDs represent a difficult-to-treat subgroup in whom additional targeted options may retain efficacy, including JAK inhibitors; however, risk assessment remains decisive because efficacy does not negate cardiovascular, malignancy, infection, or thrombosis concerns.[2][5][7][8]"
],
"bullets": [
"Target reached and treatment tolerated: continue the effective regimen with regular disease-activity reassessment.[10][12]",
"Target missed: change the DMARD strategy at the planned reassessment rather than maintaining ineffective treatment.[10]",
"New toxicity or new cardiovascular risk: reassess the mechanism choice, not only the dose or adherence.[5][7][8]",
"After two or more prior biologic DMARDs, reassess whether the patient meets a difficult-to-treat phenotype and select subsequent targeted therapy through individualized risk stratification.[2]"
],
"subsections": [],
"table": {
"caption": "Decision-triggered monitoring for rheumatoid arthritis therapy.[2][5][7][8][10][12][22]",
"columns": [
"Finding at follow-up",
"Interpretation",
"Next action"
],
"rows": [
[
"Disease activity remains above remission or low-disease-activity target.[10][12]",
"Current strategy has not achieved the prespecified treatment objective.[10]",
"Modify therapy rather than continuing the same regimen without a new endpoint.[10]"
],
[
"Methotrexate-associated gastrointestinal symptoms or suspected hepatic, pulmonary, or marrow toxicity.[22]",
"Adverse drug effect may be limiting the conventional DMARD strategy.[22]",
"Evaluate toxicity and alter the conventional DMARD plan when warranted.[22][17]"
],
[
"Herpes zoster, serious infection, or cytopenia during JAK inhibitor therapy.[5][8]",
"Recognized JAK inhibitor safety event or laboratory abnormality.[5]",
"Reassess continuation and reduce concomitant glucocorticoid exposure when feasible.[5]"
],
[
"New or worsening cardiovascular or thromboembolic risk during consideration of JAK inhibition.[5][7][8]",
"The patient-level benefit-risk balance may have changed.[7]",
"Reconsider JAK inhibitor use versus another advanced DMARD strategy and address modifiable cardiovascular risk.[7][8]"
]
]
}
}
],
"faq": [],
"references": [
{
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"detail": "www.nejm.org",
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{
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{
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"editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.",
"citations": [
{
"number": 1,
"title": "Therapies for Active Rheumatoid Arthritis after ...",
"detail": "www.nejm.org",
"url": "https://www.nejm.org/doi/full/10.1056/NEJMoa1303006",
"authors": "www.nejm.org",
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"snippet": "by JR O'Dell · 2013 · Cited by 544 — Sulfasalazine could be reduced to 500 mg twice a day if a participant had unacceptable side effects with the higher dose. Participants continued",
"score": 0.2571984
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{
"number": 2,
"title": "Therapeutic approaches for difficult-to-treat rheumatoid ...",
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"url": "https://rmdopen.bmj.com/content/12/3/e006860",
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"snippet": "Conclusions This SLR summarised evidence supporting DMARD efficacy/safety across multiple comorbidities. In patients with active RA with ≥2 prior bDMARDs, JAKi",
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{
"number": 3,
"title": "Efficacy and safety of pharmacological treatment of psoriatic arthritis",
"detail": "ard.bmj.com",
"url": "https://ard.bmj.com/content/annrheumdis/83/6/760.full.pdf",
"authors": "ard.bmj.com",
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"snippet": "of established disease- modifying antirheumatic drugs (DMARDs) on specific musculoskeletal manifestations, including synovitis,13 axial disease14 and dactylitis.15 Further-more, head- to- head trials, comparing different MOAs,16–18 as well as conventional synthetic (cs) DMARD regimens19 and strat",
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{
"number": 4,
"title": "modifying antirheumatic drugs: 2019 update",
"detail": "ard.bmj.com",
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"authors": "ard.bmj.com",
"host": "ard.bmj.com",
"snippet": "infliximab and high- dose intravenous steroid, followed by treat- to- target: a double- blind, randomised, controlled trial in new- onset, treatment- naive, rheumatoid arthritis (the idea study). Ann Rheum Dis 2014;73:75–85. 71 Lund Hetland M, Haavardsholm EA, Rudin A, et al. A multicenter ran",
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{
"number": 5,
"title": "mediated inflammatory diseases with Janus kinase inhibitors",
"detail": "ard.bmj.com",
"url": "https://ard.bmj.com/content/annrheumdis/early/2020/11/06/annrheumdis-2020-218398.full.pdf",
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"snippet": "5 D 96 9.9 V Adverse events 1 Serious infections (similar to bDMARDs), opportunistic infections including TB, Herpes zoster (increased rates compared to bDMARDs); the risk of infectious events can be lowered with reduction or elimination of concomitant glucocorticoid use.\n2b B 100 9.9 2 Rates of mal",
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{
"number": 6,
"title": "Comparative cardiovascular safety with janus kinase ...",
"detail": "rmdopen.bmj.com",
"url": "https://rmdopen.bmj.com/content/9/4/e003630",
"authors": "rmdopen.bmj.com",
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"snippet": "by H Bower · 2023 · Cited by 26 — Objectives To compare the incidence of cardiovascular (CV) events in rheumatoid arthritis (RA) treated with janus kinase inhibitors (JAKi),",
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{
"number": 7,
"title": "Waiting for JAK inhibitor safety data | RMD Open",
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"url": "https://rmdopen.bmj.com/content/8/1/e002236",
"authors": "rmdopen.bmj.com",
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"snippet": "ORAL Surveillance was a prospective, phase 3b/4, randomised, open-label, non-inferiority, safety endpoint study comparing tofacitinib and tumour necrosis factor (TNF) inhibitors, mandated as part of post-marketing requirements and commitments to the FDA (NCT02092467). Patients included had rheumatoi",
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"snippet": "This recommendation elicited much debate. On the one hand, since 2019, new data have accrued on JAKis in terms of efficacy, such as the publication of positive trials on upadacitinib in PsA.63 On the other hand, there is currently a worldwide cautionary statement issued by both the Food and Drug Adm",
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"number": 9,
"title": "Acute inflammatory arthritis | Nature Reviews Rheumatology",
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"authors": "www.nature.com",
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"snippet": "Current guidelines advocate the use of a treat-to-target serum urate strategy, with a target serum urate concentration of <5 mg/dl (<0.30 mmol/l) or <6 mg",
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"number": 10,
"title": "Treat-to-target in rheumatoid arthritis — are we there yet? | Nature Reviews Rheumatology",
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"url": "https://www.nature.com/articles/s41584-019-0170-5",
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"snippet": "Treat-to-target has been established as a guiding principle for the treatment of rheumatoid arthritis (RA) and encompasses several distinct elements: choosing a target and a method for measuring it; assessing the target at a pre-specified time point; a commitment to change the therapy if the target ",
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"number": 11,
"title": "Clinical Management of Rheumatoid Arthritis",
"detail": "www.nature.com",
"url": "https://www.nature.com/nature-index/topics/l4/clinical-management-of-rheumatoid-arthritis",
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"snippet": "Clinical management revolves around a treat-to-target strategy, aiming for sustained remission or low disease activity through regular assessment of",
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"number": 12,
"title": "Rheumatoid arthritis | Nature Reviews Disease Primers",
"detail": "www.nature.com",
"url": "https://www.nature.com/articles/nrdp20181",
"authors": "www.nature.com",
"host": "www.nature.com",
"snippet": "antirheumatic drugs. Altogether, the improved understanding of the pathogenetic processes involved, rational use of established drugs and development of new drugs and reliable assessment tools have drastically altered the lives of individuals with RA over the past 2 decades. Current strategies striv",
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{
"number": 13,
"title": "The pathogenesis of rheumatoid arthritis: Immunity",
"detail": "www.cell.com",
"url": "https://www.cell.com/immunity/fulltext/S1074-7613(22)00599-4",
"authors": "www.cell.com",
"host": "www.cell.com",
"snippet": "by S Alivernini · 2022 · Cited by 556 — The introduction of targeted-biologic and -synthetic disease modifying anti-rheumatic drugs (DMARDs) has also transformed clinical outcomes.",
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{
"number": 14,
"title": "Long-term clinical outcomes in early rheumatoid arthritis that ...",
"detail": "academic.oup.com",
"url": "https://academic.oup.com/rheumatology/article/64/3/1052/7638805",
"authors": "academic.oup.com",
"host": "academic.oup.com",
"snippet": "by SL Heckert · 2025 · Cited by 17 — With the introduction of early treat-to-target strategies, clinical outcomes in people with RA significantly improved [1][2]. In trials, functional outcomes",
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{
"number": 15,
"title": "Rheumatoid arthritis at a turning point in the era of targeted ...",
"detail": "academic.oup.com",
"url": "https://academic.oup.com/mr/advance-article/doi/10.1093/mr/roag033/8566162",
"authors": "academic.oup.com",
"host": "academic.oup.com",
"snippet": "The expansion of targeted therapies and the widespread adoption of treat-to-target strategies have substantially improved outcomes for rheumatoid arthritis (RA)",
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{
"number": 16,
"title": "2012 Update of the 2008 American College of Rheumatology recommendations for the use of disease‐modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis",
"detail": "acrjournals.onlinelibrary.wiley.com",
"url": "https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/acr.21641",
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"host": "acrjournals.onlinelibrary.wiley.com",
"snippet": "| Topic area considered | 2008 | 2012 |\n --- \n| Indications for starting or resuming DMARDs and biologic agents | ✓ | ✓ |\n| DMARDs included† | 1 Hydroxychloroquine 2 Leflunomide 3 Methotrexate 4 Minocycline 5 Sulfasalazine And, when appropriate, combination DMARD therapy with 2 or 3 DMARDs † | ",
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{
"number": 17,
"title": "Summary of the new EULAR rheumatoid arthritis guideline",
"detail": "wchh.onlinelibrary.wiley.com",
"url": "https://wchh.onlinelibrary.wiley.com/doi/10.1002/psb.1863",
"authors": "wchh.onlinelibrary.wiley.com",
"host": "wchh.onlinelibrary.wiley.com",
"snippet": "In patients with a contraindication to methotrexate leflunomide or sulfasalazine should be considered as part of the (first) treatment strategy",
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{
"number": 18,
"title": "American College of Rheumatology 2008 ...",
"detail": "onlinelibrary.wiley.com",
"url": "https://onlinelibrary.wiley.com/doi/10.1002/art.23721",
"authors": "onlinelibrary.wiley.com",
"host": "onlinelibrary.wiley.com",
"snippet": "Treatment of rheumatoid arthritis with methotrexate and hydroxychloroquine, methotrexate and sulfasalazine, or a combination of the three",
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{
"number": 19,
"title": "ara abstracts",
"detail": "onlinelibrary.wiley.com",
"url": "https://onlinelibrary.wiley.com/doi/pdf/10.1111/imj.14932",
"authors": "onlinelibrary.wiley.com",
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"snippet": "A high proportion of patients, including those with rheumatoid arthritis, are not being pre- scribed Methotrexate in combination with advanced DMARDs.",
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{
"number": 20,
"title": "Poster Abstracts Part B - 2024",
"detail": "onlinelibrary.wiley.com",
"url": "https://onlinelibrary.wiley.com/doi/10.1111/1756-185X.15346",
"authors": "onlinelibrary.wiley.com",
"host": "onlinelibrary.wiley.com",
"snippet": "Patterns of biologic and targeted synthetic DMARD utilization and treatment failure in rheumatoid arthritis patients. Shih M. Kaohsiung",
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{
"number": 21,
"title": "Rheumatoid arthritis: current approaches to drug treatment",
"detail": "wchh.onlinelibrary.wiley.com",
"url": "https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/psb.335",
"authors": "wchh.onlinelibrary.wiley.com",
"host": "wchh.onlinelibrary.wiley.com",
"snippet": "expected increase in side-effects. Other combinations include sulfasalazine, methotrexate and hydroxy- chloroquine (triple therapy). Current national",
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{
"number": 22,
"title": "Diagnosis and management of rheumatoid arthritis",
"detail": "wchh.onlinelibrary.wiley.com",
"url": "https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/psb.1945",
"authors": "wchh.onlinelibrary.wiley.com",
"host": "wchh.onlinelibrary.wiley.com",
"snippet": "by J Weddell · 2021 · Cited by 12 — Side-effects of methotrexate are common, especially gastroin- testinal symptoms (30.8%).14 Adverse effects include liver dysfunc- tion, pneumonitis and bone",
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{
"number": 23,
"title": "Poster Abstracts - 2019",
"detail": "onlinelibrary.wiley.com",
"url": "https://onlinelibrary.wiley.com/doi/10.1111/1756-185X.13545",
"authors": "onlinelibrary.wiley.com",
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"snippet": "Rheumatoid arthritis (RA) The current emphasis is to treat early RA aggressively with DMARD with/without steroids",
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{
"number": 24,
"title": "Biologics‐Based Therapy for the Treatment of Rheumatoid ...",
"detail": "ascpt.onlinelibrary.wiley.com",
"url": "https://ascpt.onlinelibrary.wiley.com/doi/10.1038/clpt.2011.278",
"authors": "ascpt.onlinelibrary.wiley.com",
"host": "ascpt.onlinelibrary.wiley.com",
"snippet": "by DL Scott · 2012 · Cited by 243 — In RA, biologics reduce joint inflammation, limit erosive damage, decrease disability, and improve quality of life.",
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],
"publishedAt": "2026-08-24T16:16:27.081170+00:00",
"updatedAt": "2026-08-24T16:16:27.081170+00:00",
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"slug": "rheumatoid-arthritis"
}