Rheumatoid arthritis (RA) is one of the most common autoimmune diseases and one of the more challenging to treat. Not only must management approaches be tailored to individual patient factors, clinicians have a growing armamentarium of treatment options. Clinical practice can vary dramatically, even with methotrexate, the most familiar disease-modifying antirheumatic drug (DMARD) in the RA toolbox.
“We have had methotrexate as our anchor drug for many years, but the ways we start the drug and escalate are very, very different when you look at how people practice and its use in clinical trials,” said Michelle Ormseth, MD, MSCI, Assistant Professor of Rheumatology, Vanderbilt University Medical Center. “There is tremendous variation in trials and when you see a patient from another clinician. The ACR’s 2021 Guideline for the Treatment of Rheumatoid Arthritis can provide a solid backbone on the most effective ways to use methotrexate and our other approaches to treating RA.”
Dr. Ormseth will review the key concepts and newest advances in treating RA during the Rheumatology Research Foundation Memorial Lecture to Honor William R. Palmer MD, MACR. CARE: Clinical Pearls: Rheumatoid Arthritis will take place on Sunday, November 13, from 3–4 p.m. ET, in Terrace Ballroom IV of the Pennsylvania Convention Center. Meeting participants have the option to attend the lecture in person or on the meeting website via livestream, or to view the lecture on demand.
The lecture is built on the ACR’s Continuing Assessment Review Evaluation (CARE) framework designed to guide rheumatologists through study for their initial American Board of Internal Medicine (ABIM) certification as well as subsequent Maintenance of Certification (MOC) requirements.
The ACR guideline is the foundation of the RA management plan, Dr. Ormseth noted, but every patient has their distinct nuances. Individual risk factors, genetics, comorbidities, psychosocial factors, and other elements all play roles in guiding clinicians as they personalize treatment. So does the ever-growing list of conventional DMARDs, biologics, and targeted small-molecule agents.
“We have five classes of biologics alone, with multiple agents within each class. That’s in addition to methotrexate and the other traditional DMARDs,” Dr. Ormseth said. “And we have newer targeted DMARDs, agents like Janus kinase (JAK) inhibitors, all with their own benefits, risks, and tweaks. They all have roles to play in addressing treatment in early RA and through the course of the disease. Knowing where they sit in the treatment algorithm is vital. It is all about individualizing treatment to maximize outcomes for each patient.”
Many rheumatologists recognize CARE as an important tool in preparing for their initial certification exam, Dr. Ormseth added. CARE is an equally important element in the MOC process and other lifelong rheumatology learning endeavors. Her lecture addresses the vital CARE questions in RA, at the level of the latest ACR treatment guideline, and the even newer agents and approaches that have developed since the last guideline literature review closed.
“For those in training, the lecture will give them a good backbone of how to handle an individual RA patient throughout the course of their disease,” Dr. Ormseth said. “Effective treatment is not just your initial choice, but thinking about how that individual patient evolves over time and how we can better customize therapy. The hour is peppered with nuances that will help even the seasoned rheumatologist shift to a more evidence-based practice.”