Segment 6 - Dosing of Methotrexate and Use of Other Agents

The panelists weighed in on the use of newer agents as well as anticoagulants in RA treatment. Dr Fendrick noted his appreciation of the panelists’ recognition of the fact that when it comes to agents, “newer isn’t always better.” He also asked what criteria they use when adding another agent to methotrexate, and how long or quickly they wait to add a second agent.

Dr Ruderman said that identifying and quantifying persistent disease activity is important, even though it can be difficult. He said that rheumatologists can make decisions about increasing doses of methotrexate, depending on a given patient’s response to the treatment option. He adds that any persistent disease activity can be reason to add another agent to methotrexate.

Dr O’Dell agreed, but noted that he believes some rheumatologists escalate doses too slowly. Because some patients may show a slow response to methotrexate, Dr O’Dell said that he often waits about 6 months before he decides whether or not to move to the next step in treating his patients with RA.