How would you approach treating a patient with active rheumatoid arthritis and a history of treated lymphoma that is currently in remission?

I would individualize treatment in each patient depending on degree of RA activity, type of lymphoma and length of time of remission with shared decision-making between myself, patient and oncologist. For moderate to high degree of activity of RA, in general, rituximab in keeping with the ACR 2021 guidelines for treatment of RA in this population would be the most likely choice. However, in patients with lymphomas that were not EBV driven or did not develop during treatment with methotrexate and have low to moderate activity, I would start with double DMARD (minimize immunosuppression)and escalate to triple DMARD if needed to treat to target including methotrexate or leflunomide if their oncologist felt low risk of recurrence.