This survey is to assess the level of agreement among the working group with the proposed recommendations. These recommendations were drafted based on discussions among the group at the APLAR 2023 Thailand meeting.
The survey will rate your agreement with each recommendation on a 5-point Likert scale (ie, 5, strongly agree; 4, agree; 3, neither agree nor disagree; 2, disagree; 1 strongly disagree); agreement by 75% of total voting group members is defined as the threshold for acceptance of a statement.
Please provide your personal information* below:
Statement 1.
A validated and practical standardised measure of disease activity should be routinely performed to measure disease activity and to assess patients’ response to treatment.
Please indicate your level of agreement with the above statement:
Statement 2.
Assessing disease activity and safety before initiating therapy and monitoring them during therapy, preferably every 1–3 months, is recommended.
Statement 3.
Methotrexate should be initiated at a dose of 7.5–15.0 mg/week and rapidly escalated to the maximum tolerated and effective dose if needed. In the case of methotrexate intolerance, other csDMARDs may be considered.
Statement 4.
Oral glucocorticoids may be considered for the control of active rheumatoid arthritis as a bridging therapy together with csDMARDs at a dose of less than 7.5 mg/day for prednisolone or equivalent and should be tapered and discontinued as soon as possible.
Statement 5.
In patients who have an inadequate response to methotrexate monotherapy without poor prognostic factors, the addition of other csDMARDs such as sulfasalazine and/or hydroxychloroquine may be considered.
Statement 6.
A b/tsDMARD should be promptly considered without delay in patients with poor prognostic factors and inadequate response to csDMARDs, as well as in those with csDMARD intolerance.
Statement 7.
Patients who do not achieve remission or low disease activity with b/tsDMARD therapy are recommended to switch to another b/tsDMARD, preferably with a different mechanism of action.
Statement 8.
b/tsDMARDs are most effective when combined with a csDMARD, particularly methotrexate. For patients intolerant to csDMARDs, an IL-6 pathway inhibitor or a tsDMARD may be preferred for monotherapy. Additionally, some TNF-α inhibitors are approved for monotherapy and may be considered.
Statement 9.
After achieving sustained remission for at least 6–12 months, tapering of cs/b/tsDMARDs may be considered following glucocorticoid withdrawal.
Statement 10.
cs/b/tsDMARDs may be tapered to the lowest effective dose.
Statement 11.
If vaccination is required during treatment, temporary discontinuation of methotrexate and delayed administration of rituximab for 1–2 weeks after vaccination may be considered if disease activity allows.
Statement 12.
Screening and management of TB, HBV and HCV infections is recommended before initiating any DMARD treatment, following national guidelines. Patients with active or chronic infections should be referred to the appropriate specialists.
Statement 13.
Surveillance is necessary for detecting malignancy and assessing the risk of cardiovascular disease.
Statement 14.
Patients with rheumatoid arthritis who are pregnant or planning pregnancy and require medical therapy should continue or switch to pregnancy compatible DMARDs to control disease activity.