The gain from starting advanced therapy was largest in early RA with high disease activity and rheumatoid factor positivity. At the first visit, record DAS28 or CDAI, rheumatoid factor and anti-CCP, erosions on imaging, and factors that affect access. That lets you and the patient weigh methotrexate alone against early combination therapy on evidence rather than habit.
- Record DAS28 or CDAI, rheumatoid factor, anti-CCP and erosions at baseline.
- Flag high disease activity with seropositivity as the group most likely to benefit from early advanced therapy.
- Reassess at 3 months and escalate if the target is not met.
- Discuss cost and access openly, including biosimilars, when considering first-line advanced therapy.
Why it matters
The patients who gain most from starting advanced therapy early are identifiable at the first visit.
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