NEW ACR2020 Draft Guidelines for the Pharmacologic Treatment of RA All the guidelines in 2 tables! 1. MTX 1st, oral > SC 2. Minimize GC! 3. TTT TTT TTT 4. Biologic/tsDMARD > Triple Tx 5. Taper MTX 1st Close to my practice; suspect will be controversial! #ACR20 #ACRambassador https://t.co/iFSlq1H65V

Abst#1717 confirms that early start of csDMARDs as 1st line tx & keeping ts/bDMARD as 2nd line tx (or more) is associated w/ a favorable outcome at 10 yrs in the ESPOIR cohort (a French multi-center cohort that followed patients w/ early RA). #ACR20 @RheumNow https://t.co/bzZiShCF97

@SSNaushon MTX remains backbone of therapy given low cost, safety profile, and long experience with it. Majority of pts do well on MTX and do not require TNFi @Rheumnow.

Patient-physician discordance seen in ~30% #rheumatoidarthritis patients starting #DMARDs - ↑Patient-reported pain & functional impairment assoc. w/ discordance - Patient-centric treatment discussions needed to reduce discordance Abs#1978 #ACR20 @RheumNow https://t.co/CdlHrBOdy0

• Prevalence and Factors Associated with Patient-Physician Discordance Among RA P…

Very strong push by #ACR20 to recc MTX in most RA patient scenarios including RA ILD, RA nodules, NAFLD in new RA guidance document @rheumnow

You have a patient with RA on 25 mg MTX SQ, tolerating well without side effects. They have moderate disease activity. Your next step: @Rheumnow. #ACR20

New #ACR RA guidelines is cost conscious: 1. DMARD naive: Preferred MTX over LEF>HCQ/SSZ and preferred MTX over biologic/tsDMARD 2. DMARD naive low DAS: HCQ or SSZ preferred >MTX>LEF 3. T2T goal LDA/remission @rheumnow (thread)

Switching or adding a DMARD in pts w/ moderate-high dz RA activity & hx of previous serious infection w/in the past 12 mos as opposed to starting/increasing GCs is conditionally recommended per draft recs of new ACR RA treatment guidelines. #ACR20 @rheumnow @CCalabreseDO

Draft #ACR20 Rx Recs for RA: MTX is conditionally recommended with NORMAL LFTs and no advanced fibrosis. Role of HCQ for NALFD has been suggested at ACR, but not enough for mod-high disease activity @RheumNow. https://t.co/QFF3BK1NF0

Draft #ACR20 Rx Recs for RA: on max tolerated MTX - add bio or tsDMARD conditional recommendation over triple therapy (MTX, HCQ, SSZ). @RheumNow. https://t.co/s6fKEW8czc