ماذا تفعل عند فشل ليفلونوميد أو سلفاسالازين في التهاب المفاصل الروماتويدي مع موانع الميثوتريكسات وغياب عوامل الإنذار السيئة

References

DOI: 10.1136/ard-2022-223356

• In patients with a contraindication to MTX (or early intolerance), leflunomide or sulfasalazine should be considered as part of the (first) treatment strategy.
• If the treatment target is not achieved with the first csDMARD strategy, in the absence of poor prognostic factors, other csDMARDs should be considered.
• Short-term glucocorticoids should be considered when initiating or changing csDMARDs, in different dose regimens and routes of administration, but should be tapered and discontinued as rapidly as clinically feasible.
• sulfasalazine has been previously recommended at a dose of 3000 mg per day and leflunomide at a dose of 20 mg per day without loading dose.
• Treatment should be aimed at reaching a target of sustained remission or low disease activity in every patient.
• Monitoring should be frequent in active disease (every 1-3 months); if there is no improvement by at most 3 months after the start of treatment or the target has not been reached by 6 months, therapy should be adjusted.