Rheumatoid arthritis: Treatment of newly diagnosed disease

NSAIDs help control the pain and inflammation of rheumatoid arthritis (RA) but do not affect disease progression: they are recommended for patients with newly diagnosed RA only as an adjunct to disease-modifying antirheumatic drug (DMARD) therapy. Reserve corticosteroids for patients who have relatively severe symptoms and significant functional impairment; even short-term use of these agents can mask the inflammatory manifestations of RA and thus impede accurate assessment by a rheumatologist. The most commonly prescribed oral DMARDs are methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide. Methotrexate is the most effective of these and has an established track record. Supplemental folic acid can reduce the severity of this DMARD's adverse GI effects. A combination of methotrexate, folic acid, and an NSAID is an excellent initial regimen that is generally well tolerated.