When to Escalate vs Optimize Therapy in Established Moderate Rheumatoid Arthritis скачать в хорошем качестве

When to Escalate vs Optimize Therapy in Established Moderate Rheumatoid Arthritis

In adults with established moderate rheumatoid arthritis and an incomplete response to methotrexate, when should clinicians escalate to biologic or targeted synthetic DMARDs versus further optimizing conventional synthetic therapy? This podcast examines a common but difficult scenario in adult patients with established moderate rheumatoid arthritis who have an incomplete response to methotrexate. The core decision is whether to escalate therapy to a biologic or targeted synthetic DMARD, or to further optimize conventional synthetic DMARDs. The challenge lies in balancing potential incremental symptom improvement against meaningful risks, particularly infection, in patients whose disease activity is neither severe nor quiescent. The discussion outlines an evidence-based framework emphasizing optimization before escalation, including subcutaneous methotrexate, combination conventional therapy, adherence assessment, and time-limited observation. It also reviews clinical triggers for escalation, the role of patient-reported quality of life, comorbidity-driven risk stratification, and the distinction between early and established disease. The focus is deliberate, stepwise decision-making under uncertainty in moderate disease. Full clinical discussion available at cmetrail.com #Rheumatology #RheumatoidArthritis #DMARDs #ClinicalDecisionMaking #AutoimmuneDisease