The French Society of Rheumatology developed a decision tree for determining the first disease modifying antirheumatic drug in a patient with very early rheumatoid arthritis. This was based on a survey of experts presented with various combinations of findings.
Patient selection: Rheumatoid Arthritis < 6 months duration
Parameters:
(1) DAS 28 (Disease Activity Score)
(2) evidence of structural damage
(3) rheumatoid factor (RF)
|
DAS 28 |
Structural Damage |
Rheumatoid Arthritis |
Drug Choice |
|
low (<= 3.2) |
no |
negative |
1, 2 |
|
low (<= 3.2) |
no |
positive |
2, 3 |
|
low (<= 3.2) |
yes |
NA |
3, 4 |
|
moderate (3.3 to 5.1) |
no |
negative |
2, 3 |
|
moderate (3.3 to 5.1) |
no |
positive |
2, 3 |
|
moderate (3.3 to 5.1) |
yes |
NA |
3, 4 |
|
high (>= 5.2) |
no |
NA |
3, 4 |
|
high (>= 5.2) |
yes |
negative |
3, 4 |
|
high (>= 5.2) |
yes |
yes |
3, 5 |
|
Drug |
Name |
|
1 |
hydroxychloroquine |
|
2 |
sulfasalazine |
|
3 |
methotrexate |
|
4 |
leflunomide |
|
5 |
etanercept |
Specialty: Immunology/Rheumatology
ICD-10: ,
