title: Therapeutic options after treatment failure in rheumatoid arthritis or spondyloarthritides.
abstract: The prognosis for patients with rheumatoid arthritis or spondyloarthritides has improved dramatically due to earlier diagnosis, recognition of the need to treat early with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), alone or in combinations, the establishment of treatment targets, and the development of biological DMARDs (bDMARDs). Many patients are now able to achieve clinical remission or low disease activity with therapy, and reduce or eliminate systemic corticosteroid use. Guidelines recommend methotrexate as a first-line agent for the initial treatment of rheumatoid arthritis; however, a majority of patients will require a change of csDMARD or step up to combination therapy with the addition of another csDMARD or a bDMARD. However, treatment failure is common and switching to a different therapy may be required. The large number of available treatment options, combined with a lack of comparative data, makes the choice of a new therapy complex and often not evidence based. We summarize and discuss evidence to inform treatment decisions in patients who require a change in therapy, including baseline factors that may predict response to therapy.
authors.affiliation: Department of Medical Sciences, UOC of Rheumatology, Azienda Ospedaliero-Universitaria S. Anna-Ferrara, University of Ferrara, Cona (FE), Italy, gvl@unife.it.
authors.forename: Marcello
authors.initials: M
authors.lastname: Govoni
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bortoluzzi
authors.forename: Andrea
authors.initials: A
authors.lastname: Lo Monaco
authors.forename: Silvano
authors.initials: S
authors.lastname: Adami
authors.forename: Olga
authors.initials: O
authors.lastname: Addimanda
authors.forename: Cristian
authors.initials: C
authors.lastname: Caimmi
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Vita
authors.forename: Clodoveo
authors.initials: C
authors.lastname: Ferri
authors.forename: Andreina
authors.initials: A
authors.lastname: Manfredi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Orsolini
authors.forename: Niccolò
authors.initials: N
authors.lastname: Possemato
authors.forename: Luca
authors.initials: L
authors.lastname: Quartuccio
authors.forename: Carlo
authors.initials: C
authors.lastname: Salvarani
authors.forename: Alen
authors.initials: A
authors.lastname: Zabotti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossini
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D011379:Prognosis; D012074:Remission Induction; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000188:drug therapy*; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D008727:Methotrexate