5th June 2025

Management

Management recommendations depend on the disease severity at presentation.

For mild disease at initial presentation:

• 1st line: DMARD monotherapy
  • 1st option: Hydroxychloroquine
  • 2nd options: Sulfasalazine, Methotrexate or Leflunomide
• Consider corticosteroids and NSAIDs in acute flares

For moderate-to-severe disease at initial presentation.

• 1st line: Methotrexate monotherapy
  • 2nd options: Sulfasalazine, Hydroxychloroquine, Leflunomide
• 2nd line: Add biological agent or targeted DMARD
  • Biological agent options: etanercept, infliximab, adalimumab, certolizumab pegol, golimumab, abatacept, rituximab, tocilizumab, sarilumab
  • DMARD options: tofacitinib, baricitinib, upadacitinib, filgotinib
• Consider corticosteroids and NSAIDs in acute flares

For pregnant or planning pregnancy patients:

• 1st line: Corticosteroids
  • 2nd line: Hydroxychloroquine or Sulfasalazine