How do you approach selecting biologic therapy vs non-biologic DMARD (such as methotrexate) as initial therapy in patients with new RA diagnosis with significant erosive disease?

In my clinical experience, not everyone is the best candidate for methotrexate. Businessmen who feel alcohol consumption is part of their ability to finish business deals are uncomfortable taking methotrexate and I am uncomfortable prescribing for them. Men and women who are hoping to bear children ...

I strongly endorse the use of methotrexate (MTX) as initial therapy in patients with a new RA diagnosis who have a significant erosive disease. Clearly, this subset of patients is likely to require a combination of therapies including concomitant MTX and a biological drug. Considerable evidence has ...

For practical purposes, would use MTx and at the same time apply for biologic prior authorization, this way I don’t lose time, however always start with MTX. It might suffice on its own, especially in sero-pos disease because is more sensitive to therapy.

I have more than several patients that have stable or healed erosions only taking MTX for years validated by repeat x-ray/MRI. Those with quite an inflammatory disease are started on MTX 15 mg weekly and in 6 weeks if still an active disease, I take them up to 25 mg weekly. If not significantly bett...

Biologics Overuse and Healthcare Costs

The overuse of biologics, costly lifelong therapies, is a prevalent issue. Discontinuing biologic therapy proves challenging due to patients transitioning between healthcare systems and rheumatologists, resulting in limited knowledge of initial presentations. I...