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Am Fam Physician. 2022;106(3):340-342

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• In patients with rheumatoid arthritis, hydroxychloroquine is recommended for initial treatment in those with low disease activity.

• Methotrexate is recommended for initial treatment of patients with rheumatoid arthritis and moderate or high disease activity.

• Rheumatoid arthritis treatment should be targeted to a standardized disease activity scale.

• In patients with rheumatoid arthritis who do not achieve low disease activity with methotrexate, triple therapy with the addition of sulfasalazine and hydroxychloroquine is as effective as adding a biologic or targeted synthetic medication, although response will be slower.

From the AFP Editors

Disease-modifying antirheumatic drugs (DMARDs) are the key to treating rheumatoid arthritis, and timely initiation can prevent joint damage. Although the multiple classes of DMARDs can make treatment decisions challenging, family physicians often prescribe these medications. DMARDs are categorized as conventional synthetic (csDMARDs), biologic (bDMARDs), and targeted synthetic (tsDMARDs). Table 1 lists DMARDs approved for rheumatoid arthritis treatment. The American College of Rheumatology (ACR) published updated guidelines focused solely on medical treatment of rheumatoid arthritis.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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