• Christoph Fiehn.
• Rheumatologie Baden-Baden GbR, Tätigkeitsschwerpunkt Klinische Immunologie Medical Center Baden-Baden.
• Dtsch. Med. Wochenschr. 2020 Apr 1; 145 (7): 474-479.

AbstractThe new guidelines for the treatment of rheumatoid arthritis with disease modifying antirheumatic drugs are based on a systematic literature research and consensus process. They define the current standard of the treatment of rheumatoid arthritis. Although they are related to the current European guidelines, in some points they are more detailed and place further emphasis.Every patient suffering from active rheumatoid arthritis (RA) is to be treated with a DMARD, but Methotrexate initially remains the first resort therapeutic measure. Treatment shall comply with the "treat-to-target" principle. The therapeutic aim in this is remission, if attainable, or at least a low disease activity. Remission here is defined as a Simplified Disease Activity Score (SDAI) of ≤ 3,3 or as meeting the so called Boolean definition. A first evaluation of response is due after 12 weeks. By that time, there should be a measurable response, defined as an improvement of at least 50 % of the Composite Score, as e. g. of DAS28. If no improvement has been achieved, treatment shall be continued with either a second DMARD strategy with conventionally synthetic DMARD (csDMARD) or an alternative with biological or targeted synthetic (b or ts) DMARD - depending on whether there are risk factors for a severe disease progression. Glucocorticoids are given initially, however they should be tapered and stopped after 3-6 months or at least reduced to a maximal dose of 5 mg/d prednisone. Both a change within b and tsDMARD as well as therapeutic de-escalation are possible measures in the further course of treatment.© Georg Thieme Verlag KG Stuttgart · New York.

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