When rheumatoid arthritis has been in sustained low disease activity or remission for at least six months, many guidelines allow cautious tapering of biologic or targeted synthetic DMARDs, usually by spacing doses or reducing them in steps rather than stopping. Agree with the patient in advance what counts as a flare, how quickly they can be seen, and that the previous dose will be restarted if needed. Most flares after tapering respond to re-escalation.
- Taper only after at least six months of stable low activity or remission.
- Reduce dose or extend intervals in steps rather than stopping outright.
- Agree flare criteria and rapid review access in advance.
- Restart the previous dose promptly if disease worsens.
Why it matters
Patients accept tapering more readily when they know how quickly they can return to what worked.
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