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Rheumatoid Arthritis

Also known as: RA · inflammatory arthritis

A chronic autoimmune symmetrical polyarthritis of the small joints (hands and feet) with early-morning stiffness lasting over 30–60 minutes; untreated it erodes joints and has systemic effects. Early DMARDs change the course.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

More common in women, typically 30s–50s; genetic (HLA) and environmental (smoking) risk factors.

Red flags — escalate / refer

Septic arthritis in a single hot joint, cervical-spine instability (atlanto-axial subluxation), vasculitis, or serious drug toxicity → urgent care.

Work-up / diagnosis

1The clinical pattern plus rheumatoid factor and anti-CCP antibodies, inflammatory markers (ESR/CRP), and imaging (X-ray/ultrasound).
2Assess disease activity (e.g., DAS28) and screen before starting immunosuppression.

Management — overview

Refer early to rheumatology and start a disease-modifying drug (methotrexate first-line) promptly to prevent erosion — treat-to-target.
A short corticosteroid course bridges symptom control; NSAIDs relieve symptoms.
Escalate to combination or biologic DMARDs if not controlled; monitor for drug toxicity and manage cardiovascular risk and comorbidity.

In-depthFull dosing & advanced protocol

Drug dosing

Methotrexate (first-line DMARD)

Disease modification — prevent erosion

Adult dose: WEEKLY dosing with folic acid, per protocol
Route: Oral / SC

Caution: Weekly not daily; monitor FBC/LFTs; teratogenic — contraception needed.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Short corticosteroid ± NSAID (± biologic if refractory)

Bridge/symptom control; escalation

Adult dose: Per protocol
Route: Oral / IM / SC

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Early DMARDs; methotrexate is weekly

There is a 'window of opportunity' — early DMARDs prevent joint damage.
Methotrexate is WEEKLY (never daily) and given with folic acid.
Screen and vaccinate before immunosuppression; beware cervical-spine instability at intubation.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Methotrexate (first-line DMARD)

Short corticosteroid ± NSAID (± biologic if refractory)

📈 Early DMARDs; methotrexate is weekly

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Methotrexate (first-line DMARD)

Short corticosteroid ± NSAID (± biologic if refractory)

📈 Early DMARDs; methotrexate is weekly

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Early DMARDs; methotrexate is weekly

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Early DMARDs; methotrexate is weekly

References